MEDICARE: MR. GEORGE WAYNE BYRAM JR. 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	RN047642 - AP02081	LA

General Provider Information

NPI Number	:	1548361520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE WAYNE BYRAM JR. CRNA

Provider Business Mailing Address
First Line	:	111 BUCKHAVEN TRL
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-7579
Country	:	US
Telephone Number	:	318-377-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PLAZA PL
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-3330
Country	:	US
Telephone Number	:	318-377-2321
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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