Provider Demographics
NPI:1194754424
Name:VERMILLION, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:VERMILLION
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 1:7008 INDIANA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6114
Mailing Address - Country:US
Mailing Address - Phone:806-698-8088
Mailing Address - Fax:806-698-8588
Practice Address - Street 1:7008 INDIANA AVE
Practice Address - Street 2:STE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6114
Practice Address - Country:US
Practice Address - Phone:806-698-8088
Practice Address - Fax:806-698-8588
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9588207Q00000X, 2083P0011X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141215101OtherFIRST CARE
TXI20218OtherUPIN
TXP00321035OtherRR MEDICARE
TX8J9471OtherBLUE CROSS/BLUE SHIELD
TX170247406Medicaid
TXI20218OtherUPIN