Healthcare Provider Details

I. General information

NPI: 1669702387
Provider Name (Legal Business Name): CHRISTOPHER L. DUGAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD ANESTHESIA SERVICES-5TH FLOOR SURGICAL TOWER
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

PO BOX 32861 ANESTHESIA SERVICES - 5TH FLOOR SURGICAL TOWER
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-8983
  • Fax: 704-355-7938
Mailing address:
  • Phone: 704-355-8983
  • Fax: 704-355-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number171167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: