Healthcare Provider Details

I. General information

NPI: 1134171663
Provider Name (Legal Business Name): DOUGLAS V TOULOUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S COULTER ST
AMARILLO TX
79106-1770
US

IV. Provider business mailing address

PO BOX 2656
BRYAN TX
77805-2656
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-1000
  • Fax:
Mailing address:
  • Phone: 806-355-9595
  • Fax: 806-353-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number549908
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: