Provider Demographics
NPI:1871650507
Name:GINTER, ELISA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:LYNN
Last Name:GINTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10659 NW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR STE 104
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5047
Practice Address - Country:US
Practice Address - Phone:954-289-4777
Practice Address - Fax:954-289-4778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251062600Medicaid
FL57132Medicare ID - Type Unspecified
FL251062600Medicaid