Provider Demographics
NPI:1558761304
Name:DAVIDHIZAR MEDICAL, PLLC
Entity Type:Organization
Organization Name:DAVIDHIZAR MEDICAL, PLLC
Other - Org Name:MYMDBCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDHIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-209-0458
Mailing Address - Street 1:4030 HIGHWAY 6 S STE 250
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-1802
Mailing Address - Country:US
Mailing Address - Phone:979-209-0458
Mailing Address - Fax:979-485-9901
Practice Address - Street 1:4030 HIGHWAY 6 S
Practice Address - Street 2:SUITE 250
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1805
Practice Address - Country:US
Practice Address - Phone:979-209-0458
Practice Address - Fax:979-485-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care