Provider Demographics
NPI:1790098614
Name:D. L. DRENNON MD PA
Entity Type:Organization
Organization Name:D. L. DRENNON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-378-9898
Mailing Address - Street 1:PO BOX 670039
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0039
Mailing Address - Country:US
Mailing Address - Phone:214-378-9898
Mailing Address - Fax:214-378-9888
Practice Address - Street 1:10830 N CENTRAL EXPY
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1050
Practice Address - Country:US
Practice Address - Phone:214-378-9898
Practice Address - Fax:214-378-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7753207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB 120914Medicare PIN
TXB 120916Medicare PIN