Healthcare Provider Details

I. General information

NPI: 1023127966
Provider Name (Legal Business Name): RONALD ALLEN DAVIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DEBUYS RD.
BILOXI MS
39531
US

IV. Provider business mailing address

12608 OAK FOREST DR
GULFPORT MS
39503-5732
US

V. Phone/Fax

Practice location:
  • Phone: 228-860-0157
  • Fax: 228-860-0157
Mailing address:
  • Phone: 228-832-3516
  • Fax: 228-832-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-053282
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR662275
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: