Basic Information
| Provider Information | |||||||||
| NPI: | 1003226556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLOWAY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LUKE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 483 N SEMORAN BLVD STE 104B | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327923800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076307330 | ||||||||
| FaxNumber: | 4076308283 | ||||||||
| Practice Location | |||||||||
| Address1: | 7751 KINGSPOINTE PKWY STE 114 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075819672 | ||||||||
| FaxNumber: | 4075819673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME125695 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.