MEDICARE: DANIEL WILSON DURRUTY SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	16-359	TX

General Provider Information

NPI Number	:	1033055025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WILSON DURRUTY SA-C

Provider Business Mailing Address
First Line	:	23100 CLAY RD APT 5302
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-8171
Country	:	US
Telephone Number	:	754-275-0526
Fax Number	:

Provider Business Practice Location Address
First Line	:	23100 CLAY RD APT 5302
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-8171
Country	:	US
Telephone Number	:	754-275-0526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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