Provider Demographics
NPI:1689633638
Name:FLETCHER, DONALD CALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CALVIN
Last Name:FLETCHER
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 1:250 W DOUGLAS AVE APT 2516
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3119
Mailing Address - Country:US
Mailing Address - Phone:650-346-7760
Mailing Address - Fax:
Practice Address - Street 1:2340 CLAY ST # 514
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-3901
Practice Address - Fax:415-600-3949
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33631207QA0401X, 207W00000X
UT10260037-1205207QA0401X
FLME0052066207W00000X, 207W00000X
CAG56961207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063296100Medicaid
FL180022165OtherRAILROAD MEDICARE
FLCA7010OtherRAILROAD MEDICARE GROUP
FL374440000Medicaid
MD863LS060Medicare PIN
VA015422B26Medicare PIN
FL10524Medicare PIN
FL374440000Medicaid
FL063296100Medicaid
FLA06506Medicare UPIN
KSKA1533001Medicare UPIN