Provider Demographics
NPI:1801869268
Name:ELLIS, JAMES BRANT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRANT
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12446 WEST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2517
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:210-525-1669
Practice Address - Street 1:12446 WEST AVE
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2517
Practice Address - Country:US
Practice Address - Phone:210-525-1668
Practice Address - Fax:210-525-1669
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4319207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7403OtherBCBS
TX102043003Medicaid
TX102043005Medicaid
TX8F7403OtherBCBS
TX8A7602Medicare PIN
TXB87736Medicare UPIN
TX102043003Medicaid