Provider Demographics
NPI:1881796639
Name:WINGATE, DANA A (DO)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:WINGATE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:A
Other - Last Name:WINGATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:906 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2844
Mailing Address - Country:US
Mailing Address - Phone:817-461-4288
Mailing Address - Fax:
Practice Address - Street 1:1011 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:214-320-7185
Practice Address - Fax:972-289-3683
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7250207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF90990Medicare ID - Type Unspecified