Provider Demographics
NPI:1518944008
Name:ELLERMEYER, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:ELLERMEYER
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1382207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122881902Medicaid
TX122881906Medicaid
TX122881909OtherMEDICAID CSHCN
TX83773KOtherBCBS
TX122881908OtherMEDICAID CSHCN
TX050065093OtherRAILROAD
TX122881901Medicaid
TX122881905Medicaid
TX122881907OtherMEDICAID CSHCN
TXTXB107440Medicare PIN
TX122881902Medicaid
TX88959KMedicare PIN
TX122881909OtherMEDICAID CSHCN
TX122881907OtherMEDICAID CSHCN
TX122881908OtherMEDICAID CSHCN