MEDICARE: DR. JAMES BRANT ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	E4319	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F7403	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801869268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BRANT ELLIS MD

Provider Business Mailing Address
First Line	:	12446 WEST AVE
Second Line	:	STE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2517
Country	:	US
Telephone Number	:	210-525-1668
Fax Number	:	210-525-1669

Provider Business Practice Location Address
First Line	:	12446 WEST AVE
Second Line	:	STE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2517
Country	:	US
Telephone Number	:	210-525-1668
Fax Number	:	210-525-1669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	06/14/2016

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