Individual
MICHAEL GARY ELLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2692 N GALLOWAY, 402, MESQUITE, TX 75150-2636
(972) 682-3909
(972) 682-9289
Mailing address
PO BOX 850304, MESQUITE, TX 75185-0304
(972) 682-3909
(972) 682-9289
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J3092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12249902
—
TX
Enumeration date
09/21/2006
Last updated
05/20/2008
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