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General NPI Number Information
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NPI Number | 1679508352
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Entity Type | Individual
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Provider Name | RODNEY JAY ELLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 2 TAMPA GENERAL CIR FL 3
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City | TAMPA
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State | FL
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Zip | 33606-3571
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Country | US
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Telephone | 813-844-7585
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1289
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City | TAMPA
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State | FL
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Zip | 33601-1289
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Country | US
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Telephone | 813-844-7585
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD467778
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME120553
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License Number State | FL
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