Provider Demographics
NPI:1194787432
Name:MEAD, DONALD T (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:MEAD
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 1:34 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4233
Mailing Address - Country:US
Mailing Address - Phone:785-979-9771
Mailing Address - Fax:
Practice Address - Street 1:6582 MAGRATH AVE
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4277
Practice Address - Country:US
Practice Address - Phone:719-526-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-251272083X0100X
CODR00547442083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100379270BMedicaid
KS100379270BMedicaid
KSF90075Medicare UPIN