Healthcare Provider Details

I. General information

NPI: 1710091343
Provider Name (Legal Business Name): COLBY J ALEXANDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 S FOREST AVE
GILBERT AZ
85298-9170
US

IV. Provider business mailing address

6916 S FOREST AVE
GILBERT AZ
85298-9170
US

V. Phone/Fax

Practice location:
  • Phone: 480-310-0107
  • Fax:
Mailing address:
  • Phone: 480-310-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0537
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: