Provider Demographics
NPI:1801891635
Name:DOERRFELD, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DOERRFELD
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:PO BOX 847176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:802 MEDICAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5153
Practice Address - Country:US
Practice Address - Phone:903-315-2710
Practice Address - Fax:903-315-5092
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6838207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030729004Medicaid
TX030729004Medicaid
TXTXB147914Medicare PIN