Organization Name: | MDPA SOLUTIONS, INC |
NPI Number: | 1992181077 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ELLIS FRANKLIN FORT (PHYSICIAN ASSISTANT) |
Mailing Address: | 1431 S Dixie Fwy Ste B New Smyrna Beach |
State: | FL US |
Postal Code: | 321687604 |
Phone Number: | 3869573810 |
Fax Number: | 3869573859 |
NPI Enumeration Date: | 07/30/2015 |
NPI Last Update Date: | 07/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME102682 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |