Provider Demographics
NPI:1710973748
Name:SARGENT, DAVID WEIGAND (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WEIGAND
Last Name:SARGENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-885-6534
Mailing Address - Fax:903-885-5109
Practice Address - Street 1:101 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2105
Practice Address - Country:US
Practice Address - Phone:903-885-6534
Practice Address - Fax:903-885-5109
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8822207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168019102Medicaid
TXE92416Medicare UPIN
TX168019102Medicaid