Healthcare Provider Details

I. General information

NPI: 1033318381
Provider Name (Legal Business Name): JAY HOWARD SEYMOUR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N LEWIS ST
NEW IBERIA LA
70563-2043
US

IV. Provider business mailing address

PO BOX 53533
LAFAYETTE LA
70505-3533
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-3168
  • Fax: 337-369-3536
Mailing address:
  • Phone: 337-406-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05215
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: