=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245777440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID P ELLENT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2017
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2255 E MOSSY OAKS RD STE 500
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77389-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-440-5300
-----------------------------------------------------
Fax | 281-975-1001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2255 E MOSSY OAKS RD STE 500
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77389-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-975-1000
-----------------------------------------------------
Fax | 281-975-1001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. DAVID P ELLENT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-440-5300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | L7366
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------