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General NPI Number Information
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NPI Number | 1972806925
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ANESTHESIA LLC
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD 1000W
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-715-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 13601 PRESTON RD 1000W
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-715-5000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS WEBSTER
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Credential | DO
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Telephone | 972-715-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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