Organization
DAN A. WADDELL, D.O., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN A WADDELL D.O. (PRESIDENT)
(817) 267-0550
Entity
Organization
Contact information
Practice address
88 VILLAGE LN, SUITE 105, COLLEYVILLE, TX 76034-2972
(817) 267-0550
(817) 545-2368
Mailing address
88 VILLAGE LN, SUITE 105, COLLEYVILLE, TX 76034-2972
(817) 267-0550
(817) 545-2368
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D7703
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0028QH
BCBS
TX
05
—
191097801
—
TX
01
—
DN4715
MEDICARE RAILROAD
—
Enumeration date
06/07/2007
Last updated
10/20/2008
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