Provider Demographics
NPI:1720036981
Name:DELWOOD, DONALD M (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:DELWOOD
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 1:401 KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6625
Mailing Address - Country:US
Mailing Address - Phone:573-876-1666
Mailing Address - Fax:573-874-0665
Practice Address - Street 1:401 KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6625
Practice Address - Country:US
Practice Address - Phone:573-876-1666
Practice Address - Fax:573-874-0665
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D49207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201970811Medicaid
MO201970811Medicaid
0959Medicare ID - Type Unspecified