Provider Demographics
NPI:1790924298
Name:ELLIS, JAISHREE RIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAISHREE
Middle Name:RIVA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAISHREE
Other - Middle Name:RIVA
Other - Last Name:SCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2028 WIRT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1602
Mailing Address - Country:US
Mailing Address - Phone:713-682-7066
Mailing Address - Fax:832-916-2813
Practice Address - Street 1:820 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8326
Practice Address - Country:US
Practice Address - Phone:903-343-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9998207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology