MEDICARE: DR. OWEN BERNARDO ELLINGTON M.D, J.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
1	207RH0003X	Hematology & Oncology Physician	A30345	CA
2	207RH0003X	Hematology & Oncology Physician	H5109	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	:	1396703310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OWEN BERNARDO ELLINGTON M.D, J.D.

Provider Business Mailing Address
First Line	:	14007 COLE POINT DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-1109
Country	:	US
Telephone Number	:	713-304-4227
Fax Number	:	281-277-0491

Provider Business Practice Location Address
First Line	:	14007 COLE POINT DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-1109
Country	:	US
Telephone Number	:	713-304-4227
Fax Number	:	281-277-0491

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/15/2023

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