Individual
DR. BRUCE ELKIN ELLERIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
721 CLINIC DR, TYLER, TX 75701-2043
(903) 535-6312
(903) 535-6330
Mailing address
721 CLINIC DR, TYLER, TX 75701-2043
(903) 533-6312
(903) 535-6330
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
L8679
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010046338
AMERICHOICE
—
01
—
1825753
AETNA
—
05
—
1984247-03
—
TX
05
—
1984247-04
—
TX
01
—
3K8111
HEALTHNET
—
01
—
P3883771
OXFORD
—
Enumeration date
08/03/2005
Last updated
04/19/2019
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