1164430997 NPI number — MR. DAVID GLENN TURNER PA-C

Table of content: MR. DAVID GLENN TURNER PA-C (NPI 1164430997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164430997 NPI number — MR. DAVID GLENN TURNER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER
Provider First Name:
DAVID
Provider Middle Name:
GLENN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164430997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
149 S. US HWY 59
Provider Business Mailing Address City Name:
GARRISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75946-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-347-3322
Provider Business Mailing Address Fax Number:
936-347-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 SOUTH U.S. HWY 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARRISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-347-3322
Provider Business Practice Location Address Fax Number:
936-347-3325
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154304467 . This is a "MEDICAL DIRECTOR'S" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA01924 . This is a "PA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 158535801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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