Individual
ELLIS ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12700 PARK CENTRAL DR, STE 430, DALLAS, TX 75251-1527
(972) 239-8902
Mailing address
PO BOX 740608, DALLAS, TX 75374-0608
(469) 317-9900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J7162
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128943103
—
TX
Enumeration date
05/31/2005
Last updated
02/04/2021
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