Healthcare Provider Details

I. General information

NPI: 1861483547
Provider Name (Legal Business Name): CESAR JONATHAN BAYLON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 SUGAR HILRD L
TEXARKANA AR
71854
US

IV. Provider business mailing address

173 BEACON HILL RD
DE QUEEN AR
71832
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-2442
  • Fax:
Mailing address:
  • Phone: 870-584-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00724
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: