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General NPI Number Information
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NPI Number | 1124255583
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Entity Type | Individual
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Provider Name | DANNY LEE DENNIS JR. IDMT
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 939 MISSILE ROAD BLD 1900
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City | WICHITA FALLS
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-0815
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Fax |
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Provider Business Mailing Address
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Address Line | 5602 GREENTREE AVE.
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City | WICHITA FALLS
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State | TX
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Zip | 76306
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Country | US
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Telephone | 334-546-7379
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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