Healthcare Provider Details

I. General information

NPI: 1558464347
Provider Name (Legal Business Name): JAMES DOYLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

22195 POCKET RD
BATESVILLE IN
47006-7494
US

V. Phone/Fax

Practice location:
  • Phone: 800-277-8151
  • Fax:
Mailing address:
  • Phone: 812-934-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28104766A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: