Healthcare Provider Details

I. General information

NPI: 1831129592
Provider Name (Legal Business Name): CURTIS L SANFORD II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 YOUNGSVILLE HWY
LAFAYETTE LA
70508-4524
US

IV. Provider business mailing address

2644 S. SHERWOOD FOREST BLVD. SUITE 121
BATON ROUGE LA
70816-2248
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-2080
  • Fax:
Mailing address:
  • Phone: 225-293-3587
  • Fax: 225-293-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number04372
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: