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NPI Code Detail

MEDICARE: DR. DAVID DALE ELLIS D.O.

MEDICARE: DR. DAVID DALE ELLIS D.O.
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
1207Q00000XFamily Medicine PhysicianF3931TX

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 : 1174514137
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID DALE ELLIS D.O.
Provider Business Mailing Address
First Line : 720 PLEASANTON RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78214-1306
Country : US
Telephone Number : 210-921-3800
Fax Number : 210-921-6615
Provider Business Practice Location Address
First Line : 720 PLEASANTON RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78214-1306
Country : US
Telephone Number : 210-921-3800
Fax Number : 210-921-6615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 02/01/2010

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Directions to “ DR. DAVID DALE ELLIS D.O.” Practice Location

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