Provider Demographics
NPI:1285661157
Name:SISK, DANA L (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:SISK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-583-3111
Mailing Address - Fax:
Practice Address - Street 1:2201 N STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2345
Practice Address - Country:US
Practice Address - Phone:903-583-3111
Practice Address - Fax:903-583-1444
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE6174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120363001Medicaid
TX1203630-06Medicaid
B26481Medicare UPIN
TX1203630-06Medicaid