MEDICARE: DR. DAVID JOSEPH VINING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	D42965	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043238819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOSEPH VINING M.D.

Provider Business Mailing Address
First Line	:	1400 PRESSLER ST
Second Line	:	FCT 15.6038
City	:	HOUSTON
State	:	TX
Zip	:	77030-3722
Country	:	US
Telephone Number	:	713-792-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PRESSLER ST
Second Line	:	FCT 15.6038
City	:	HOUSTON
State	:	TX
Zip	:	77030-3722
Country	:	US
Telephone Number	:	713-792-3437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/24/2012

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