Individual
B KEITH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
16651 SOUTHWEST FWY, MOB 1, SUITE 400, SUGAR LAND, TX 77479-2345
(713) 776-9500
(713) 400-7220
Mailing address
16651 SOUTHWEST FWY, MOB 1, SUITE 400, SUGAR LAND, TX 77479-2345
(713) 776-9500
(713) 400-7220
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
L7368
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166000303
—
TX
05
—
166000304
—
TX
05
—
166000305
—
TX
05
—
166000306
—
TX
01
—
1821046780
BLUE CROSS BLUE SHIELD
TX
01
—
8DJ181
BCBS
TX
01
—
P01086528
RR MEDICARE
—
01
—
P01301854
RR MEDICARE
TX
Enumeration date
05/04/2006
Last updated
02/01/2017
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