Provider Demographics
NPI:1699799155
Name:HEAD, DONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:HEAD
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:249 CRAIG ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831-7707
Practice Address - Country:US
Practice Address - Phone:903-322-4072
Practice Address - Fax:903-322-4069
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8540208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138779719Medicaid
TXC16746Medicare UPIN
TX347436YSVGMedicare PIN