Individual
DR. WARREN ALDRICH ELLSWORTH IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6560 FANNIN ST, SUITE 2200, HOUSTON, TX 77030-2761
(713) 441-8082
(713) 790-5020
Mailing address
6560 FANNIN ST, SUITE 2200, HOUSTON, TX 77030-2761
(713) 441-8082
(713) 790-5020
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
N4396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336470343
BLUE CROSS BLUE SHIELD
TX
01
—
8EJ452
BLUE CROSS BLUE SHIELD
TX
01
—
P00947675
MEDICARE RR
TX
Enumeration date
01/15/2010
Last updated
07/07/2014
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