Provider Demographics
NPI:1417586991
Name:CHISUM, DAVID WESTLY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WESTLY
Last Name:CHISUM
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 1:1975 N VETERANS BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4456
Mailing Address - Country:US
Mailing Address - Phone:830-213-8186
Mailing Address - Fax:830-213-8157
Practice Address - Street 1:1975 N VETERANS BLVD STE 9
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4456
Practice Address - Country:US
Practice Address - Phone:830-213-8186
Practice Address - Fax:830-213-8157
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine