Provider Demographics
NPI:1518955129
Name:FOSDICK, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:FOSDICK
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 1:8230 WALNUT HILL LN STE 208
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4409
Mailing Address - Country:US
Mailing Address - Phone:214-692-6135
Mailing Address - Fax:214-692-6265
Practice Address - Street 1:8230 WALNUT HILL LN STE 208
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4409
Practice Address - Country:US
Practice Address - Phone:214-692-6135
Practice Address - Fax:214-692-6265
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9637208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113986705Medicaid
TX113986705Medicaid
TXTXB108715Medicare PIN