Healthcare Provider Details

I. General information

NPI: 1053346593
Provider Name (Legal Business Name): PAUL T BEISSER III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 BOX
DUBOIS WY
82513-1492
US

IV. Provider business mailing address

P.O. BOX 1492
DUBOIS WY
82513-1492
US

V. Phone/Fax

Practice location:
  • Phone: 208-351-2887
  • Fax:
Mailing address:
  • Phone: 208-351-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50101
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberN-31082
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: