Provider Demographics
NPI:1679612030
Name:DONALD D. DILWORTH, M.D., P.A.
Entity Type:Organization
Organization Name:DONALD D. DILWORTH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-657-2100
Mailing Address - Street 1:8715 VILLAGE DR STE 608
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5407
Mailing Address - Country:US
Mailing Address - Phone:210-657-2100
Mailing Address - Fax:210-657-2110
Practice Address - Street 1:8715 VILLAGE DR STE 608
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5407
Practice Address - Country:US
Practice Address - Phone:210-657-2100
Practice Address - Fax:210-657-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106014703Medicaid
TXG52709Medicare UPIN
TX106014703Medicaid