Provider Demographics
NPI:1184842064
Name:MISSIMO, DAVID RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:MISSIMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4608 STONEHOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7522
Mailing Address - Country:US
Mailing Address - Phone:972-381-8618
Mailing Address - Fax:
Practice Address - Street 1:5824 W PLANO PKWY
Practice Address - Street 2:104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4636
Practice Address - Country:US
Practice Address - Phone:972-818-9355
Practice Address - Fax:972-818-9356
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJO1332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry