Provider Demographics
NPI:1003226556
Name:ELLOWAY, RICHARD LUKE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LUKE
Last Name:ELLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:483 N SEMORAN BLVD STE 104B
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-630-7330
Mailing Address - Fax:407-630-8283
Practice Address - Street 1:7751 KINGSPOINTE PKWY STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-581-9672
Practice Address - Fax:407-581-9673
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine