Provider Demographics
NPI:1023064524
Name:DILWORTH, DONALD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:DILWORTH
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 1:8715 VILLAGE DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-657-2100
Mailing Address - Fax:210-675-2110
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-657-2100
Practice Address - Fax:210-675-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2893208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106014701Medicaid
TX106014701Medicaid
TXG52709Medicare UPIN