Provider Demographics
NPI:1518939842
Name:VOLLING, DWIGHT C (DPM)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:C
Last Name:VOLLING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4901
Mailing Address - Country:US
Mailing Address - Phone:361-664-1121
Mailing Address - Fax:361-664-3668
Practice Address - Street 1:72 N WRIGHT ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4901
Practice Address - Country:US
Practice Address - Phone:361-664-1121
Practice Address - Fax:361-664-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX0576213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018705601Medicaid
T16425Medicare UPIN
TX018705601Medicaid