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General NPI Number Information
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NPI Number | 1922404524
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Entity Type | Individual
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Provider Name | DANIEL ERIC PENDLEBURY AU.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 700 E 17TH ST ATTN: HEARING AID CENTER
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6152
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Country | US
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Telephone | 208-406-6925
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Fax |
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Provider Business Mailing Address
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Address Line | 275 MARJACQ AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4016
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Country | US
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Telephone | 208-406-6925
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD-2632
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License Number State | ID
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