Provider Demographics
NPI:1205879343
Name:LOUNSBERRY, DAVID V (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
Last Name:LOUNSBERRY
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 1:2450 ORO DAM BLVD E
Mailing Address - Street 2:SUITE D
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6052
Mailing Address - Country:US
Mailing Address - Phone:530-538-3171
Mailing Address - Fax:
Practice Address - Street 1:2450 ORO DAM BLVD E
Practice Address - Street 2:SUITE D
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6052
Practice Address - Country:US
Practice Address - Phone:530-538-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3828716Medicaid
TN3828717Medicaid
TN38287151Medicare PIN
TN3828716Medicaid
TN3828717Medicare PIN
TN3828717Medicaid