MEDICARE: DUSTIN MAX MCDERMOTT 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	208600000X	Surgery Physician	01060359A	IN
2	208600000X	Surgery Physician	N3172	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00923240	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1154387538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN MAX MCDERMOTT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4207
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75606-4207
Country	:	US
Telephone Number	:	903-315-2762
Fax Number	:	903-315-2595

Provider Business Practice Location Address
First Line	:	703 E MARSHALL AVE
Second Line	:	SUITE 3000
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5500
Country	:	US
Telephone Number	:	903-315-2762
Fax Number	:	903-315-2595

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/22/2025

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Directions to “ DUSTIN MAX MCDERMOTT M.D.” Practice Location

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