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General NPI Number Information
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NPI Number | 1851307003
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Entity Type | Individual
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Provider Name | DAVID WAYNE OVERTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1315 RUDDELL RD SE
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City | LACEY
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State | WA
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Zip | 98503-5701
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Country | US
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Telephone | 360-357-8054
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Fax | 360-236-9703
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Provider Business Mailing Address
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Address Line | 5408 S BAY TER NE
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City | OLYMPIA
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State | WA
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Zip | 98516-9629
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10001318
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License Number State | WA
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