Provider Demographics
NPI:1679276307
Name:ELLERHORST, ALEX DAVID (DO)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:DAVID
Last Name:ELLERHORST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 BEACON HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-4442
Mailing Address - Country:US
Mailing Address - Phone:614-788-2510
Mailing Address - Fax:
Practice Address - Street 1:5131 BEACON HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4442
Practice Address - Country:US
Practice Address - Phone:614-788-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.033593207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty