Provider Demographics
NPI:1275945602
Name:ELLIS, DENNIS R
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:ELLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 ENNIS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6131
Mailing Address - Country:US
Mailing Address - Phone:713-523-6600
Mailing Address - Fax:866-300-6601
Practice Address - Street 1:6205 SAXON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6246
Practice Address - Country:US
Practice Address - Phone:713-523-6600
Practice Address - Fax:866-300-6601
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant