Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | Q7037 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q7037 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | Q7037 | TX |
NPI | 1013237080 |
---|---|
Provider Name | Matthew David Ellington |
First Address | Austin, TX 78723-3077 |
Second Address | Austin, TX 78723-3077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2010 |
Last Update Date | 26/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3581332-01 | (05) | TX |
3581332-02 | (05) | TX |
3581332-03 | (05) | TX |
3581332-04 | (05) | TX |