Provider Demographics
NPI:1386630309
Name:HOUSTON, DAVID D (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:HOUSTON
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 1:202 HILTY DRIVE
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-0299
Mailing Address - Country:US
Mailing Address - Phone:419-384-3251
Mailing Address - Fax:419-384-3269
Practice Address - Street 1:202 HILTY DRIVE
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877-9703
Practice Address - Country:US
Practice Address - Phone:419-384-3251
Practice Address - Fax:419-384-3269
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-4917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0471412Medicaid
OHE67601Medicare UPIN
OH0487111Medicare ID - Type Unspecified