Individual
DR. BENTON R. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
H8020
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050065923
RAILROAD
—
05
—
128452303
—
TX
05
—
128452304
—
TX
05
—
128452306
—
TX
05
—
128452307
—
TX
01
—
128452308
MEDICAID CSHCN
TX
01
—
128452309
MEDICAID CSHCN
TX
01
—
128452310
MEDICAID CSHCN
TX
01
—
83841K
BCBS
TX
Enumeration date
12/21/2005
Last updated
06/07/2018
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