Provider Demographics
NPI:1972535524
Name:ELLIS, JAY S JR (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:ELLIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 HUEBNER RD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3253
Mailing Address - Country:US
Mailing Address - Phone:210-692-0101
Mailing Address - Fax:210-692-7615
Practice Address - Street 1:9819 HUEBNER RD STE 113
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3253
Practice Address - Country:US
Practice Address - Phone:210-692-0101
Practice Address - Fax:210-692-7615
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6069207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1513566-01Medicaid
TX1513566-01Medicaid
TX8731M6Medicare ID - Type Unspecified