Provider Demographics
NPI:1043328552
Name:SANCHEZ, DAVID WAYNE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:SANCHEZ
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 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4704
Mailing Address - Country:US
Mailing Address - Phone:432-837-5505
Mailing Address - Fax:432-837-9118
Practice Address - Street 1:202 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4704
Practice Address - Country:US
Practice Address - Phone:432-837-5505
Practice Address - Fax:432-837-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1567261QR1300X, 207Q00000X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111586702Medicaid
TX111586703Medicaid
TX111586701Medicaid
TX129492807Medicaid
TX129492801Medicaid
TXF55899Medicare UPIN
TX111586703Medicaid
TX00N30XMedicare ID - Type UnspecifiedPART B
TX129492801Medicaid
TXTXB126823Medicare PIN