| NPI | 1699979203 |
|---|---|
| Doing Business As | ROBERT G ELLISON JR MD |
| Entity Type | Organization |
| Authorized Contact | ROBERT G ELLISON Owner 904-388-7521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME39556) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2007-08-10 |