Individual
DR. JON MICHAEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 HILLCREST MEDICAL BLVD STE 2, WACO, TX 76712-8897
(254) 741-1400
(254) 741-1428
Mailing address
PO BOX 848491, DALLAS, TX 75284-8491
(254) 202-9330
(254) 202-9349
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
J9580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046446302
—
TX
Enumeration date
06/22/2005
Last updated
09/25/2020
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