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General NPI Number Information
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NPI Number | 1225883564
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Entity Type | Organization
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Legal Business Name | PERMIAN ARTHRITIS AND RHEUMATOLOGY CENTER
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 8050 E HIGHWAY 191 STE 203
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City | ODESSA
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State | TX
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Zip | 79765-8615
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Country | US
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Telephone | 432-326-1939
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Fax | 432-224-1091
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Provider Business Mailing Address
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Address Line | PO BOX 14955
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City | ODESSA
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State | TX
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Zip | 79768-4955
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Country | US
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Telephone | 432-326-1939
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Fax | 432-224-1091
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CANDACE WYNNE
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Credential |
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Telephone | 432-349-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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