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General NPI Number Information
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NPI Number | 1548525652
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Entity Type | Individual
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Provider Name | DANNY WAYNE PELTON ATP
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 36532 FM 2481
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City | HICO
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State | TX
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Zip | 76457-3313
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Country | US
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Telephone | 254-644-0422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | HICO
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State | TX
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Zip | 76457-0579
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Country | US
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Telephone | 254-644-0422
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Fax | 254-796-2648
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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