MEDICARE: MR. RAYMOND JAMES DEVLIN III MSN, CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN094909APO04479	LA

General Provider Information

NPI Number	:	1235121971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND JAMES DEVLIN III MSN, CRNA

Provider Business Mailing Address
First Line	:	16513 HOWARD ST
Second Line	:	APT D
City	:	FORT POLK
State	:	LA
Zip	:	71459-2535
Country	:	US
Telephone Number	:	337-537-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	16513 HOWARD ST
Second Line	:	APT D
City	:	FORT POLK
State	:	LA
Zip	:	71459-2535
Country	:	US
Telephone Number	:	337-537-5375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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