Provider Demographics
NPI:1144242348
Name:FLETCHER, DAVID KING (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KING
Last Name:FLETCHER
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 1:816 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2016
Mailing Address - Country:US
Mailing Address - Phone:903-592-2999
Mailing Address - Fax:903-593-5190
Practice Address - Street 1:816 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2016
Practice Address - Country:US
Practice Address - Phone:903-592-2999
Practice Address - Fax:903-593-5190
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8971208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115069004Medicaid
TXP00063511OtherRAILROAD MEDICARE
TX0036KVOtherBLUE CROSS GROUP NUMBER
TX0036KVOtherBLUE CROSS GROUP NUMBER
TX00894VMedicare PIN
TXC15607Medicare UPIN