Provider Demographics
NPI:1316110638
Name:STAPENHORST, DAVID PERRIN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PERRIN
Last Name:STAPENHORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 HIGHWAY 6
Mailing Address - Street 2:SUITE 174
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4914
Mailing Address - Country:US
Mailing Address - Phone:281-980-0999
Mailing Address - Fax:281-980-0444
Practice Address - Street 1:4665 SWEETWATER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3135
Practice Address - Country:US
Practice Address - Phone:281-980-0999
Practice Address - Fax:281-980-0444
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2015-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM5522208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3212631-01Medicaid
TX200309YL5MMedicare PIN