Provider Demographics
NPI:1629074034
Name:PRICE, DAVID THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:PRICE
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 1:1111 W FRANK AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-632-0074
Mailing Address - Fax:936-632-0081
Practice Address - Street 1:1111 W FRANK AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-632-0074
Practice Address - Fax:936-632-0081
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020511208800000X
TXM7537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60989304Medicaid
TXTXB124432OtherMEDICARE PTAN
TX27-3173597OtherTAX IDENTIFICATION NUMBER