Provider Demographics
NPI:1497803704
Name:COLUMBUS, DONALD GORDON (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GORDON
Last Name:COLUMBUS
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 1:413 THE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-6021
Mailing Address - Country:US
Mailing Address - Phone:830-598-1908
Mailing Address - Fax:
Practice Address - Street 1:413 THE HILLS RD
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-6021
Practice Address - Country:US
Practice Address - Phone:830-598-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4277207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21942Medicare UPIN