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Individual
ROBERT S ELLIS
Active
Individual
ROBERT S ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
M1656
TX
2086S0127X
Trauma Surgery Physician
Primary
M1656
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178944801
—
TX
01
—
86515S
BCBS
—
01
—
8BC264
BCBS OF TEXAS
TX
01
—
TIN PLUS 096
TRICARE
TX
Enumeration date
01/09/2007
Last updated
03/08/2022
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