Individual
DR. DAVID M. LAVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 8TH AVE, SUITE 200, FORT WORTH, TX 76104-2619
(817) 335-6457
(817) 334-0491
Mailing address
800 8TH AVE, SUITE 200, FORT WORTH, TX 76104-2619
(817) 335-6457
(817) 334-0491
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E0082
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N791
BLUE CROSS BLUE SHIELD
TX
01
—
4019441
AETNA
TX
Enumeration date
03/24/2006
Last updated
07/08/2007
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