Individual
DR. LANCE A. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1507 W MAIN ST, GATESVILLE, TX 76528-1024
(254) 865-2166
(254) 248-0626
Mailing address
1507 W MAIN ST, GATESVILLE, TX 76528-1024
(254) 865-2166
(254) 248-0626
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
34-007955
OH
207XS0117X
Orthopaedic Surgery of the Spine Physician
5101015902
MI
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
M4053
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M4053
TX
207XX0801X
Orthopaedic Trauma Physician
34-007955
OH
207XX0801X
Orthopaedic Trauma Physician
5101015902
MI
207XX0801X
Orthopaedic Trauma Physician
M4053
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M4053
STATE LICENSE
TX
Enumeration date
03/27/2006
Last updated
07/31/2023
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