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General NPI Number Information
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NPI Number | 1740688837
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Entity Type | Individual
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Provider Name | CODY PAINTER LAT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 43021 6TH AND BOSTON
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City | LUBBOCK
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State | TX
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Zip | 79401
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Country | US
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Telephone | 214-592-2486
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Fax |
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Provider Business Mailing Address
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Address Line | 6309 HANCOCK RD
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City | ROWLETT
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State | TX
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Zip | 75089-8251
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Country | US
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Telephone | 214-592-2486
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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 | AT5919
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License Number State | TX
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