Provider Demographics
NPI:1104092972
Name:ELLIS, NEIL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:JAMES
Last Name:ELLIS
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 1:540 CARILLON PKWY
Mailing Address - Street 2:3062
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1204
Mailing Address - Country:US
Mailing Address - Phone:352-275-8909
Mailing Address - Fax:
Practice Address - Street 1:4730 N HABANA AVE STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7165
Practice Address - Country:US
Practice Address - Phone:727-548-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12201207L00000X
FLME115797208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology