Healthcare Provider Details

I. General information

NPI: 1659457125
Provider Name (Legal Business Name): DAVID SCHLOSSER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S ROOSEVELT AVE
GOLDENDALE WA
98620-9201
US

IV. Provider business mailing address

310 S ROOSEVELT AVE
GOLDENDALE WA
98620-9201
US

V. Phone/Fax

Practice location:
  • Phone: 509-773-4022
  • Fax: 509-773-1941
Mailing address:
  • Phone: 509-773-4022
  • Fax: 509-773-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number202000768
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: