Healthcare Provider Details

I. General information

NPI: 1013949197
Provider Name (Legal Business Name): DAVID EGERTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 WALLACE BLVD ATTN: CREDENTIALING DEPT.
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-351-3777
  • Fax: 806-351-3765
Mailing address:
  • Phone: 806-351-3777
  • Fax: 806-351-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24263
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number24263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: