MEDICARE: DR. ELLIS GERARD MAIN 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
1	261QR1300X	Rural Health Clinic/Center	J2176	TX
2	207Q00000X	Family Medicine Physician	J2176	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1366440919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIS GERARD MAIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 10426
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78460-0426
Country	:	US
Telephone Number	:	361-387-9233
Fax Number	:	361-387-8992

Provider Business Practice Location Address
First Line	:	327 W AVENUE J
Second Line	:
City	:	ROBSTOWN
State	:	TX
Zip	:	78380-2207
Country	:	US
Telephone Number	:	361-387-9233
Fax Number	:	361-387-8992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/16/2025

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