Provider Demographics
NPI:1407060783
Name:DAVID MEDUNA, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID MEDUNA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-764-6868
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:STE 3100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-764-6868
Mailing Address - Fax:979-694-8804
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:STE 3100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-764-6868
Practice Address - Fax:979-694-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275726853OtherCOLLEGE STATION CLINIC
TX187842302Medicaid
TX1821185299OtherBVCAA AGENCY
TX0026PVOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX184841802Medicaid
TX187842301Medicaid
671861Medicare Oscar/Certification
TX187842301Medicaid