Provider Demographics
NPI:1659310597
Name:DRUMMOND, WAYMON (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYMON
Middle Name:
Last Name:DRUMMOND
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 1:5959 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6234
Mailing Address - Country:US
Mailing Address - Phone:214-638-1773
Mailing Address - Fax:214-631-3561
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6234
Practice Address - Country:US
Practice Address - Phone:214-638-1773
Practice Address - Fax:214-631-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083741101Medicaid
TX083741102Medicaid
TX083741101Medicaid