Healthcare Provider Details

I. General information

NPI: 1790098614
Provider Name (Legal Business Name): D. L. DRENNON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 N CENTRAL EXPY SUITE 120
DALLAS TX
75231-1050
US

IV. Provider business mailing address

PO BOX 670039
DALLAS TX
75367-0039
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-9898
  • Fax: 214-378-9888
Mailing address:
  • Phone: 214-378-9898
  • Fax: 214-378-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. D L DRENNON
Title or Position: OWNER
Credential: MD
Phone: 214-378-9898