MEDICARE: FREDERICK S UTTER 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	CRNA00801	NM
2	367500000X	Certified Registered Nurse Anesthetist	04035	TX
3	367500000X	Certified Registered Nurse Anesthetist	AP102926	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	040435	OTHER	COUNCIL NURSE ANESTHETIST

General Provider Information

NPI Number	:	1306845508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK S UTTER CRNA

Provider Business Mailing Address
First Line	:	3947 LAS VEGAS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1728
Country	:	US
Telephone Number	:	915-772-4551
Fax Number	:	915-232-9920

Provider Business Practice Location Address
First Line	:	1900 DENVER AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-3008
Country	:	US
Telephone Number	:	915-577-0111
Fax Number	:	915-533-2568

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/16/2022

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