Individual
MR. DARRELL LAYNE GANUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED, LAT, ATC
Contact information
Practice address
301 N KILGORE ST, KILGORE, TX 75662-5825
(903) 983-3307
(903) 983-3211
Mailing address
806 WOODLAWN ST, KILGORE, TX 75662-3650
(903) 983-3307
(903) 983-3211
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1246
TX
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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