Fentress, Dustin R

Fentress, Dustin R is an individual health care provider with primary practice located at 102 N Magdalen St , San Angelo TX 76903-5400. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Fentress, Dustin R can be contacted via phone (325) 658-1511.

Contact Information

Primary practice address
102 N Magdalen St San Angelo TX 76903-5400
Phone: (325) 658-1511
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA00000 Texas

Profile Details

NPI number 1487841151
LBN Legal business name Fentress, Dustin R
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2007
Last updated May 24th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487841151 NPPES
Texas MEDICAID 189613601
Texas Other 1079653

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