Organization
ELLIS SURGICAL PAVILION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J. D. FAJARDO D.P.M. (CEO)
(972) 938-1368
Entity
Organization
Contact information
Practice address
1014 FERRIS AVE, STE. 214, WAXAHACHIE, TX 75165-2599
(972) 938-1368
Mailing address
1014 FERRIS AVE, STE. 214, WAXAHACHIE, TX 75165-2599
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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