Provider Demographics
NPI:1699074831
Name:PERSYN, DANETTE MARLENE (MD)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:MARLENE
Last Name:PERSYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10077 GROGANS MILL RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1000
Mailing Address - Country:US
Mailing Address - Phone:281-465-3600
Mailing Address - Fax:281-465-3608
Practice Address - Street 1:10077 GROGANS MILL RD
Practice Address - Street 2:SUITE 460
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1000
Practice Address - Country:US
Practice Address - Phone:281-465-3600
Practice Address - Fax:281-465-3608
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3067208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice