Provider Demographics
NPI:1154537041
Name:GOLOVKO, DMITRY (MD)
Entity type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:GOLOVKO
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 1:3507 104TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-5149
Mailing Address - Country:US
Mailing Address - Phone:806-771-1995
Mailing Address - Fax:806-771-1997
Practice Address - Street 1:3507 104TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-5149
Practice Address - Country:US
Practice Address - Phone:806-771-1995
Practice Address - Fax:806-771-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL15922083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine