MEDICARE: DWIGHT A DAVID MD

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	208D00000X	General Practice Physician	A40764	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110232328	OTHER	CA	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A407640	OTHER	CA	BLUE SHIELD
2	A40764	OTHER	CA	BCBS
3	B010	OTHER	CA	CHAMPUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487653531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT A DAVID MD

Provider Business Mailing Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	STE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

Provider Business Practice Location Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	STE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/07/2007

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Directions to “ DWIGHT A DAVID MD” Practice Location

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