Provider Demographics
NPI:1235661018
Name:VINTHER, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VINTHER
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 1:409 RUSSELL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1248
Mailing Address - Country:US
Mailing Address - Phone:936-569-8204
Mailing Address - Fax:936-560-6962
Practice Address - Street 1:409 RUSSELL BLVD STE D
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1248
Practice Address - Country:US
Practice Address - Phone:936-569-8204
Practice Address - Fax:936-560-6962
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty