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NPI Code Detail

MEDICARE: DR. NEIL JAMES ELLIS M.D.

MEDICARE: DR. NEIL JAMES ELLIS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianTRN12201FL
2208VP0014XInterventional Pain Medicine PhysicianME115797FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104092972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NEIL JAMES ELLIS M.D.
Provider Business Mailing Address
First Line : 540 CARILLON PKWY
Second Line : 3062
City : ST PETERSBURG
State : FL
Zip : 33716-1204
Country : US
Telephone Number : 352-275-8909
Fax Number :
Provider Business Practice Location Address
First Line : 4730 N HABANA AVE STE 104
Second Line :
City : TAMPA
State : FL
Zip : 33614-7165
Country : US
Telephone Number : 727-548-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2008
Last Update Date : 08/08/2019

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