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General NPI Number Information
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NPI Number | 1104431576
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Entity Type | Individual
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Provider Name | GREGORY ALLAN FENCHEL JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 1501 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1770
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Country | US
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Telephone | 806-354-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 HILLSIDE RD APT 1101
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City | AMARILLO
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State | TX
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Zip | 79119-8316
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Country | US
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Telephone | 505-306-6869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1011950
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License Number State | TX
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