Healthcare Provider Details

I. General information

NPI: 1831436468
Provider Name (Legal Business Name): DREW DARBY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S ROCK ST
GEORGETOWN TX
78626-5837
US

IV. Provider business mailing address

1004 S ROCK ST
GEORGETOWN TX
78626-5837
US

V. Phone/Fax

Practice location:
  • Phone: 512-279-0348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number754682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: