Healthcare Provider Details

I. General information

NPI: 1023166410
Provider Name (Legal Business Name): RICHARD JOSEPH BAZIK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WAYNE MEMORIAL DRIVE
GOLDSBORO NC
27534
US

IV. Provider business mailing address

2700 WAYNE MEMORIAL DRIVE
GOLDSBORO NC
27534
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-6068
  • Fax: 919-731-6025
Mailing address:
  • Phone: 919-731-6068
  • Fax: 919-731-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number139810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26721
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: