Provider Demographics
NPI:1932101078
Name:LONDON, DYNAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DYNAL
Middle Name:M
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6900 SCENIC DR
Mailing Address - Street 2:STE 103
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-2695
Mailing Address - Country:US
Mailing Address - Phone:972-412-1034
Mailing Address - Fax:972-475-5708
Practice Address - Street 1:6900 SCENIC DR
Practice Address - Street 2:STE 103
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-2695
Practice Address - Country:US
Practice Address - Phone:972-412-1034
Practice Address - Fax:972-475-5708
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83241SOtherBLUECROSS OF TEXAS
TX83241SOtherBLUECROSS OF TEXAS