Provider Demographics
NPI:1659600161
Name:ELLSWORTH, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ELLSWORTH
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 1:20214 BRAIDWOOD DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2138
Mailing Address - Country:US
Mailing Address - Phone:281-579-3600
Mailing Address - Fax:281-579-2467
Practice Address - Street 1:20214 BRAIDWOOD DR
Practice Address - Street 2:SUITE 215
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2138
Practice Address - Country:US
Practice Address - Phone:281-579-3600
Practice Address - Fax:281-579-2467
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine