Healthcare Provider Details

I. General information

NPI: 1699733980
Provider Name (Legal Business Name): BOBBY JAMES HUMBLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

IV. Provider business mailing address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-1349
  • Fax: 713-790-0028
Mailing address:
  • Phone: 985-649-7070
  • Fax: 713-790-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number722279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: