Provider Demographics
NPI:1811085749
Name:CANLAS, ELLERY E (MD)
Entity type:Individual
Prefix:
First Name:ELLERY
Middle Name:E
Last Name:CANLAS
Suffix:
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 1:571 WETHERSFIELD PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1879
Mailing Address - Country:US
Mailing Address - Phone:321-622-4752
Mailing Address - Fax:
Practice Address - Street 1:245 S COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4831
Practice Address - Country:US
Practice Address - Phone:321-453-5326
Practice Address - Fax:321-452-8507
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101792207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology