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Individual
DWIGHT A DAVID
Active
Individual
DWIGHT A DAVID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A40764
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A407640
BLUE SHIELD
CA
05
—
00A407640
—
CA
01
—
110232328
MEDICARE RAIL ROAD
CA
01
—
A40764
BCBS
CA
01
—
B010
CHAMPUS
CA
Enumeration date
07/20/2005
Last updated
12/07/2007
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