ELLIS ROBERTSON MD NPI 1568465920

NPI Information

  • NPI: 1568465920
  • Provider Name: ELLIS ROBERTSON, MD
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 12700 PARK CENTRAL DR
    STE 430
    DALLAS, TX
    ZIP 75251
  • Phone: (972) 239-8902

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NPI Details

Ellis Robertson, MD is a diagnostic radiology radiology in Dallas, TX with 37 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Ellis Robertson, MD NPI is 1568465920. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Graduation Year:1989

The provider's business location address is:

12700 PARK CENTRAL DR
STE 430
DALLAS, TX
ZIP 75251-527
Phone: (972) 239-8902

The NPI 1568465920 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/31/2005 and was last updated on 2/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyJ7162TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1128943103MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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