Provider Demographics
NPI:1396703310
Name:ELLINGTON, OWEN BERNARDO (MD, JD)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:BERNARDO
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:DR
Other - First Name:OWEN
Other - Middle Name:B
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,JD
Mailing Address - Street 1:14007 COLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1109
Mailing Address - Country:US
Mailing Address - Phone:713-304-4227
Mailing Address - Fax:281-277-0491
Practice Address - Street 1:14007 COLE POINT DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1109
Practice Address - Country:US
Practice Address - Phone:713-304-4227
Practice Address - Fax:281-277-0491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30345207RH0003X
TXH5109207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1255333-05Medicaid
TX00533HMedicare ID - Type Unspecified
TX1255333-05Medicaid