Ellenberg, Evan

Ellenberg, Evan is an sole proprietor health care provider with primary practice located at 12111 Panama City Beach Pkwy , Panama City Beach FL 32407-2609. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ellenberg, Evan can be contacted via phone (850) 588-1066.

Contact Information

Primary practice address
12111 Panama City Beach Pkwy Panama City Beach FL 32407-2609
Phone: (850) 588-1066
Fax: (850) 588-1036
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X PA9108571 Florida

Profile Details

NPI number 1225420334
LBN Legal business name Ellenberg, Evan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 26th, 2015
Last updated May 27th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225420334 NPPES
Other 1225420334 INSURANCE

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