Provider Demographics
NPI:1023122686
Name:JOHN, DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4206 CALL FIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2519
Mailing Address - Country:US
Mailing Address - Phone:940-397-5200
Mailing Address - Fax:940-397-5287
Practice Address - Street 1:4206 CALLFIELD ROAD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2519
Practice Address - Country:US
Practice Address - Phone:940-397-5200
Practice Address - Fax:940-397-5287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122412303Medicaid
TXF61000Medicare UPIN
TX00971LMedicare PIN