Healthcare Provider Details

I. General information

NPI: 1891950283
Provider Name (Legal Business Name): ROBERT E GRAMLING III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 23RD AVE EAST MISSISSIPPI ENDOSCOPY CENTER
MERIDIAN MS
39301-3107
US

IV. Provider business mailing address

101 GREENBRIAR ST
STARKVILLE MS
39759-4302
US

V. Phone/Fax

Practice location:
  • Phone: 601-485-1131
  • Fax:
Mailing address:
  • Phone: 601-408-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR862292
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: