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General NPI Number Information
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NPI Number | 1154485829
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Entity Type | Individual
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Provider Name | DICKSON AARON ELLINGTON PA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1405 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5732
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Country | US
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Telephone | 305-624-9191
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Fax | 305-643-7772
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Provider Business Mailing Address
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Address Line | PO BOX 530442
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City | MIAMI SHORES
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State | FL
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Zip | 33153-0442
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Country | US
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Telephone | 786-390-5424
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Fax | 305-754-9387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3313
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License Number State | FL
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