MEDICARE: DOUG BAYSINGER II

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	603686	TX

General Provider Information

NPI Number	:	1609853167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG BAYSINGER II

Provider Business Mailing Address
First Line	:	714 FM 1960 RD W
Second Line	:	SUITE 206
City	:	HOUSTON
State	:	TX
Zip	:	77090-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HIGHWAY 59 LOOP N
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-7807
Country	:	US
Telephone Number	:	979-532-2500
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/08/2007

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