Healthcare Provider Details

I. General information

NPI: 1962554915
Provider Name (Legal Business Name): JAMES SCOTT ELLIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 SOUTH HAMPTON RD SUITE D107
DALLAS TX
75224
US

IV. Provider business mailing address

PO BOX 381329
DUNCANVILLE TX
75138
US

V. Phone/Fax

Practice location:
  • Phone: 214-333-9175
  • Fax: 214-333-4609
Mailing address:
  • Phone: 214-333-9175
  • Fax: 214-333-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0G1383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: