Provider Demographics
NPI:1023081411
Name:DELAPLANE, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DELAPLANE
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 1:3350 EXECUTIVE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6878
Mailing Address - Country:US
Mailing Address - Phone:325-245-4000
Mailing Address - Fax:325-245-4040
Practice Address - Street 1:3350 EXECUTIVE DR STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6878
Practice Address - Country:US
Practice Address - Phone:325-245-4500
Practice Address - Fax:325-245-4040
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36705207R00000X
VA0101235979207R00000X
TXR9743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA100312OtherMEDICARE-TRAILBLAZER HEALTH
VA1023081411Medicaid