MEDICARE: ENNIS VETERINARY CLINIC PC

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	174M00000X	Veterinarian

General Provider Information

NPI Number	:	1992711378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENNIS VETERINARY CLINIC PC

Provider Business Mailing Address
First Line	:	3101 NORTH KAUFMAN ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-7920
Country	:	US
Telephone Number	:	972-875-2647
Fax Number	:	972-875-2648

Provider Business Practice Location Address
First Line	:	3101 NORTH KAUFMAN ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-7920
Country	:	US
Telephone Number	:	972-875-2647
Fax Number	:	972-875-2648

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID NORMAN CHANCELLOR
Credential	:	DVM
Telephone Number	:	972-875-2647

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/22/2020

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