Provider Demographics
NPI:1003808551
Name:ELLISON, PAUL STRIBLING JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STRIBLING
Last Name:ELLISON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100210 OVERSEAS HWY
Mailing Address - Street 2:STE 3
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2526
Mailing Address - Country:US
Mailing Address - Phone:305-453-3633
Mailing Address - Fax:305-453-3637
Practice Address - Street 1:100210 OVERSEAS HWY
Practice Address - Street 2:STE 3
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2526
Practice Address - Country:US
Practice Address - Phone:305-453-3633
Practice Address - Fax:305-453-3637
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2022-03-01
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLME0064771207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379646900Medicaid
F67907Medicare UPIN
FL23444Medicare PIN