Provider Demographics
NPI:1063750099
Name:LANKFORD, DAWUD OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:DAWUD
Middle Name:OMAR
Last Name:LANKFORD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3106
Mailing Address - Country:US
Mailing Address - Phone:510-455-2699
Mailing Address - Fax:510-982-2226
Practice Address - Street 1:3300 WEBSTER ST STE 103
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3106
Practice Address - Country:US
Practice Address - Phone:510-455-2699
Practice Address - Fax:510-982-2226
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC150490208800000X
NY268676208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04295667Medicaid