Provider Demographics
NPI:1760505184
Name:KLOPFENSTEIN, GAYLON DWAIN (LSA, CFA)
Entity Type:Individual
Prefix:
First Name:GAYLON
Middle Name:DWAIN
Last Name:KLOPFENSTEIN
Suffix:
Gender:M
Credentials:LSA, CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 PARK BROOK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-0901
Mailing Address - Country:US
Mailing Address - Phone:817-690-8708
Mailing Address - Fax:817-577-5793
Practice Address - Street 1:8412 PARK BROOK CT
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-0901
Practice Address - Country:US
Practice Address - Phone:817-690-8708
Practice Address - Fax:817-577-5793
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00014363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical