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General NPI Number Information
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NPI Number | 1902074560
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Entity Type | Individual
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Provider Name | DARNELL A BRUNDAGE LAT
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Gender | Male
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | BOX T-0080
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City | STEPHENVILLE
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State | TX
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Zip | 76402-0001
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Country | US
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Telephone | 254-968-1809
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Fax |
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Provider Business Mailing Address
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Address Line | 340 S BARTON ST
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City | STEPHENVILLE
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State | TX
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Zip | 76401-5721
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT3686
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License Number State | TX
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