Provider Demographics
NPI:1861479222
Name:CHEATHAM, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8335 WALNUT HILL LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4216
Mailing Address - Country:US
Mailing Address - Phone:214-368-6424
Mailing Address - Fax:214-360-9012
Practice Address - Street 1:8335 WALNUT HILL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4216
Practice Address - Country:US
Practice Address - Phone:214-368-6424
Practice Address - Fax:214-360-9012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX891690OtherBLUE CROSS BLUE SHIELD
TX891690OtherBLUE CROSS BLUE SHIELD
TXB21805Medicare UPIN