Healthcare Provider Details

I. General information

NPI: 1053584334
Provider Name (Legal Business Name): DAVID P. STAPENHORST, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 SWEETWATER BLVD SUITE 110
SUGAR LAND TX
77479-3135
US

IV. Provider business mailing address

4665 SWEETWATER BLVD SUITE 110
SUGAR LAND TX
77479-3135
US

V. Phone/Fax

Practice location:
  • Phone: 281-980-0999
  • Fax:
Mailing address:
  • Phone: 281-980-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberM5522
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM5522
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID PERRIN STAPENHORST
Title or Position: DIRECTOR
Credential: M.D.
Phone: 281-980-0999