KENNETH ROBERT ELLISON

FORT WALTON BEACH, FL
NPI1831122803
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: FL  9106823)
Enumeration Date2006-07-10
Last Update Date2022-01-14
Business Address
-- KENNETH ROBERT ELLISON PA
1032 MAR WALT DR SUITE 250
FORT WALTON BEACH, FL 32547-6661
Phone number: 850-863-3463
Mailing Address
-- KENNETH ROBERT ELLISON PA
1032 MAR WALT DR SUITE 250
FORT WALTON BEACH, FL 32547-6661
Phone number: 850-863-3463
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