Provider Demographics
NPI:1124036884
Name:WHITCOMB, DONALD CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CRAIG
Last Name:WHITCOMB
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 1:2461 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3852
Mailing Address - Country:US
Mailing Address - Phone:972-606-1334
Mailing Address - Fax:972-606-1637
Practice Address - Street 1:2461 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3852
Practice Address - Country:US
Practice Address - Phone:972-606-1334
Practice Address - Fax:972-606-1637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034483001Medicaid
TX080014510OtherRR MEDICARE
TX00KB43Medicare UPIN