Provider Demographics
NPI:1669421160
Name:GREENWELL, DAVID PAYTON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAYTON
Last Name:GREENWELL
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 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:
Practice Address - Street 1:2503 N US HIGHWAY 281 STE 400
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-3863
Practice Address - Country:US
Practice Address - Phone:830-693-5889
Practice Address - Fax:830-693-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0308208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030625002Medicaid
TX8DK722Medicare PIN
TXH14991Medicare UPIN