Healthcare Provider Details

I. General information

NPI: 1609986801
Provider Name (Legal Business Name): ROBERT G BAYLIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT G BAYLIS CRNA

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3882 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5803
US

IV. Provider business mailing address

PO BOX 1684
PASCAGOULA MS
39568-1684
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-6290
  • Fax: 228-762-0065
Mailing address:
  • Phone: 228-762-9080
  • Fax: 228-762-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR111550
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: