# ANDREA M ELLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063661148
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | BP10032729 | TX | — |
| 207Q00000X | Family Medicine Physician | N7419 | TX | Yes |

## Other

- **Enumeration date:** 09/15/2008
- **Last updated:** 12/03/2024

## 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 |