Provider Demographics
NPI:1720082274
Name:DONALDSON, DAVID LANCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LANCE
Last Name:DONALDSON
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 1:4005 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1835
Mailing Address - Country:US
Mailing Address - Phone:806-792-2767
Mailing Address - Fax:806-791-6709
Practice Address - Street 1:4005 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1835
Practice Address - Country:US
Practice Address - Phone:806-792-2767
Practice Address - Fax:888-861-8858
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK55132085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1928084OtherFIRST HEALTH
TX300132042OtherRAILROAD MEDICARE
NM78150060Medicaid
TX111790101OtherFIRSTCARE
TX118702307Medicaid
TX8G1351OtherBLUECROSS
TX118702307Medicaid
TX8980B6Medicare PIN