Provider Demographics
NPI:1811981590
Name:TOWNSEND, DWIGHT A (MD)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:A
Last Name:TOWNSEND
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 1:19207 TERRA ROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2343
Mailing Address - Country:US
Mailing Address - Phone:361-548-1249
Mailing Address - Fax:
Practice Address - Street 1:19207 TERRA ROCK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-2343
Practice Address - Country:US
Practice Address - Phone:361-548-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK48172085B0100X, 2085R0202X
FLME990522085R0202X
GA812762085R0202X
VA01012655722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001743000Medicaid
G95529Medicare UPIN
FL001743000Medicaid