MEDICARE: MR. DOUGLAS JAMES DESZELL 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	ARNP1453122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407828858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JAMES DESZELL CRNA

Provider Business Mailing Address
First Line	:	PO BOX 286
Second Line	:
City	:	MONTICELLO
State	:	FL
Zip	:	32345-0286
Country	:	US
Telephone Number	:	850-673-1001
Fax Number	:	850-997-6076

Provider Business Practice Location Address
First Line	:	75 E 5TH CT
Second Line	:
City	:	GREENVILLE
State	:	FL
Zip	:	32331-5201
Country	:	US
Telephone Number	:	850-673-1001
Fax Number	:	850-997-6076

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	05/12/2008

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