MEDICARE: JAY S. ELLIS JR. 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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	G6069	TX
2	207L00000X	Anesthesiology Physician	G6069	TX

General Provider Information

NPI Number	:	1972535524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY S. ELLIS JR. M.D.

Provider Business Mailing Address
First Line	:	9819 HUEBNER RD STE 113
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3253
Country	:	US
Telephone Number	:	210-692-0101
Fax Number	:	210-692-7615

Provider Business Practice Location Address
First Line	:	9819 HUEBNER RD STE 113
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3253
Country	:	US
Telephone Number	:	210-692-0101
Fax Number	:	210-692-7615

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/05/2024

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