MEDICARE: RICHARD ELLER MD PA

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	208600000X	Surgery Physician	H9908	TX

General Provider Information

NPI Number	:	1275924243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD ELLER MD PA

Provider Business Mailing Address
First Line	:	18800 PRESTON RD STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18800 PRESTON RD STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8573
Country	:	US
Telephone Number	:	214-619-5225
Fax Number	:	214-619-5222

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD ELLER
Credential	:	MD
Telephone Number	:	214-619-5225

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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