Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | N 3019 | TX |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | N 3019 | TX |
NPI | 1821200494 |
---|---|
Provider Name | Dr. Henry Bone Ellis JR. |
First Address | Dallas, TX 75219-3924 |
Second Address | Frisco, TX 75034-9580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 07/03/2019 |