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General NPI Number Information
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NPI Number | 1912903055
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Entity Type | Individual
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Provider Name | GREGORY TODD PARKHURST CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 950 N 14TH ST STE 100
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City | BEAUMONT
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State | TX
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Zip | 77702-1112
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Country | US
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Telephone | 409-833-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 COLONIAL DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3092
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Country | US
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Telephone | 936-645-9950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 596293
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License Number State | TX
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