Provider Demographics
NPI:1487730511
Name:SYN, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SYN
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 1:3805 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1117
Mailing Address - Country:US
Mailing Address - Phone:806-687-5670
Mailing Address - Fax:
Practice Address - Street 1:3805 22ND PLACE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1117
Practice Address - Country:US
Practice Address - Phone:806-687-5670
Practice Address - Fax:806-687-5673
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5583174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75136350Medicaid
TX159948201Medicaid
NM75136350Medicaid
TX8A5308Medicare ID - Type UnspecifiedPART B