Provider Demographics
NPI:1700829827
Name:OVSON, ELLEN ANDREWS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ANDREWS
Last Name:OVSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CORPORATE SQ BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-855-4364
Mailing Address - Fax:904-661-3757
Practice Address - Street 1:1900 CORPORATE SQ BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-855-4364
Practice Address - Fax:904-661-3757
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4183207RA0401X
MS183382084A0401X
FLME133564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01620810Medicaid
AL009932742Medicaid
AL009932742Medicaid
MS790000009Medicare ID - Type Unspecified