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General NPI Number Information
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NPI Number | 1265635031
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Entity Type | Organization
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Legal Business Name | DAN A. WADDELL, D.O., PLLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 88 VILLAGE LN SUITE 105
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City | COLLEYVILLE
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State | TX
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Zip | 76034-2972
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Country | US
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Telephone | 817-267-0550
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Fax | 817-545-2368
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Provider Business Mailing Address
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Address Line | 88 VILLAGE LN SUITE 105
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City | COLLEYVILLE
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State | TX
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Zip | 76034-2972
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Country | US
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Telephone | 817-267-0550
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Fax | 817-545-2368
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN A WADDELL
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Credential | D.O.
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Telephone | 817-267-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D7703
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License Number State | TX
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