Provider Demographics
NPI:1477555191
Name:WAY, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 LANDA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5417
Mailing Address - Country:US
Mailing Address - Phone:830-625-2335
Mailing Address - Fax:830-625-2338
Practice Address - Street 1:457 LANDA ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5417
Practice Address - Country:US
Practice Address - Phone:830-625-2335
Practice Address - Fax:830-625-2338
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089467701Medicaid
TX089467701Medicaid
TXTXB153440Medicare PIN