Provider Demographics
NPI:1114345212
Name:EZELL, ELLEN MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MITCHELL
Last Name:EZELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MICHELLE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 W MORSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3749
Mailing Address - Country:US
Mailing Address - Phone:407-629-5555
Mailing Address - Fax:407-629-4884
Practice Address - Street 1:701 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3749
Practice Address - Country:US
Practice Address - Phone:407-629-5555
Practice Address - Fax:407-629-4884
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME145344208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program