Provider Demographics
NPI:1427081710
Name:ELLENT, DAVID PETER (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:ELLENT
Suffix:
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 1:2255 E MOSSY OAKS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1813
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:281-624-4702
Practice Address - Street 1:22751 PROFESSIONAL DR STE 140
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6024
Practice Address - Country:US
Practice Address - Phone:281-975-1000
Practice Address - Fax:281-783-2505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7366207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111815002Medicaid
TX111815002Medicaid