Individual
DR. BEAU JAMES ELLENBECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
610 E BYRON NELSON BLVD, SUITE 101, ROANOKE, TX 76262-6541
(817) 912-8200
(817) 912-8210
Mailing address
610 E BYRON NELSON BLVD, SUITE 101, ROANOKE, TX 76262-6541
(817) 912-8200
(817) 912-8210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P1069
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307543401
—
TX
Enumeration date
05/29/2007
Last updated
03/16/2023
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