Healthcare Provider Details

I. General information

NPI: 1235392689
Provider Name (Legal Business Name): DAVID GERARDO BARRAZA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 DONVILLE ROAD SUITE E
DECATUR AL
35603
US

IV. Provider business mailing address

PO BOX 5750
DECATUR AL
35601
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-9040
  • Fax: 256-355-9048
Mailing address:
  • Phone: 256-355-9040
  • Fax: 256-355-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13452
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number1-091621
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-091621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: