Provider Demographics
NPI:1336393479
Name:ELLSWORTH, RACHEL JOY (MD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:JOY
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:832-522-3240
Mailing Address - Fax:281-578-2404
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:832-522-3240
Practice Address - Fax:281-578-2404
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTMB PIT#390200000X
TXN1878208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342229702Medicaid
TX342229701Medicaid
TX8GD754OtherBCBS
TX8EQ602OtherBCBS
TX342229701Medicaid
TX342229702Medicaid