Individual
DUSTIN R FENTRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
102 N MAGDALEN ST, SAN ANGELO, TX 76903-5400
(325) 658-1511
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1079653
CERTIFICATION
TX
05
—
189613601
—
TX
Enumeration date
09/26/2007
Last updated
05/24/2013
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