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Individual
ANDREA M ELLIS
Active
Individual
ANDREA M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10032729
TX
207Q00000X
Family Medicine Physician
Primary
N7419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284827701
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
752616977077
TRICARE
TX
01
—
752616977118
TRICARE
TX
01
—
8CU926
BCBS
TX
Enumeration date
09/15/2008
Last updated
12/03/2024
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