Provider Demographics
NPI:1770586620
Name:SAWISKY, DAVID L SR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SAWISKY
Suffix:SR
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 1:1039 N TWIN CITY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-3851
Mailing Address - Country:US
Mailing Address - Phone:409-722-0026
Mailing Address - Fax:409-729-2783
Practice Address - Street 1:1039 N TWIN CITY HWY STE B
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627
Practice Address - Country:US
Practice Address - Phone:409-722-0026
Practice Address - Fax:409-729-2783
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05364OtherCIGNA
TX2220051OtherAETNA
TXP00004282OtherRAILROAD MEDICARE
TX8H3102OtherBLUE CROSS
TXP00004282OtherRAILROAD MEDICARE
TX8A2373Medicare ID - Type UnspecifiedMEDICARE
TXP00004282OtherRAILROAD MEDICARE