Healthcare Provider Details

I. General information

NPI: 1831176049
Provider Name (Legal Business Name): EDGAR LEE GARNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 QUAIL CREEK DR STE 103
AMARILLO TX
79124-1634
US

IV. Provider business mailing address

7100 W 9TH AVE
AMARILLO TX
79106-1704
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-7911
  • Fax: 806-358-9600
Mailing address:
  • Phone: 806-355-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number231154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: