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General NPI Number Information
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NPI Number | 1508826074
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Entity Type | Individual
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Provider Name | LANCE A. ELLIS DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1507 W MAIN ST
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City | GATESVILLE
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State | TX
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Zip | 76528-1024
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Country | US
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Telephone | 254-865-2166
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Fax | 254-248-0626
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Provider Business Mailing Address
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Address Line | 1507 W MAIN ST
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City | GATESVILLE
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State | TX
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Zip | 76528-1024
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Country | US
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Telephone | 254-865-2166
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Fax | 254-248-0626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 5101015902
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 34-007955
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | M4053
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | M4053
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 5101015902
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 34-007955
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | M4053
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License Number State | TX
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