Healthcare Provider Details

I. General information

NPI: 1184797060
Provider Name (Legal Business Name): DONALD L DRENNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 N CENTRAL EXPY #120
DALLAS TX
75231
US

IV. Provider business mailing address

PO BOX 670039
DALLAS TX
75367-0039
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-9898
  • Fax:
Mailing address:
  • Phone: 214-378-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG7753
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: