Provider Demographics
NPI:1386624476
Name:MALDONADO, DAVID III (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MALDONADO
Suffix:III
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:PO BOX 822087
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-2087
Mailing Address - Country:US
Mailing Address - Phone:817-263-6116
Mailing Address - Fax:817-263-6117
Practice Address - Street 1:1701 GLADE RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4322
Practice Address - Country:US
Practice Address - Phone:817-263-6116
Practice Address - Fax:817-263-6117
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2441207RC0200X, 207RH0002X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196242501Medicaid
TX377919ZKWAMedicare PIN
TX196242501Medicaid