Healthcare Provider Details

I. General information

NPI: 1104919711
Provider Name (Legal Business Name): DAVID J WARE II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND STREET SE
MAGEE MS
39111
US

IV. Provider business mailing address

402 REBECCA AVE
HATTIESBURG MS
39401
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-5070
  • Fax:
Mailing address:
  • Phone: 601-297-7629
  • Fax: 601-582-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR857666
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: