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NPI Code Detail

MEDICARE: RENEE ANN ELLIS M.D.

MEDICARE: RENEE ANN ELLIS M.D.
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
1207RN0300XNephrology Physician31193SC
2207RN0300XNephrology PhysicianW0564TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134391733
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE ANN ELLIS M.D.
Provider Business Mailing Address
First Line : 1902 WINDSOR PL STE 102
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1866
Country : US
Telephone Number : 682-207-1700
Fax Number : 682-250-5246
Provider Business Practice Location Address
First Line : 1902 WINDSOR PL STE 102
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1866
Country : US
Telephone Number : 682-207-1700
Fax Number : 682-250-5246
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2008
Last Update Date : 01/09/2026

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Directions to “ RENEE ANN ELLIS M.D.” Practice Location

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