Provider Demographics
NPI:1669495685
Name:ELLIS, MATTHEW J (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ
Mailing Address - Street 2:BCM 600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-798-1847
Mailing Address - Fax:713-798-1642
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 1350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-1999
Practice Address - Fax:713-798-1990
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ2126207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO904430183Medicaid
IL$$$$$$$$$Medicaid
IL$$$$$$$$$Medicaid
MOP00047458Medicare PIN