Provider Demographics
NPI:1417198722
Name:ELLIS, PATRICK ANDREWS (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANDREWS
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100B E ALTON GLOOR BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 B E ALTON GLOOR BLVD SUITE 160
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3376
Practice Address - Country:US
Practice Address - Phone:956-350-2245
Practice Address - Fax:956-350-9557
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4395207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219500002Medicaid
TXTXB160440Medicare PIN