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NPI Code Detail

MEDICARE: LARRY DEAN SMITH C.R.N.A.

MEDICARE: LARRY DEAN SMITH C.R.N.A.
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
1367500000XCertified Registered Nurse Anesthetist225690TX

General Provider Information

NPI Number : 1700888260
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY DEAN SMITH C.R.N.A.
Provider Business Mailing Address
First Line : 100 S PARK DR
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-5918
Country : US
Telephone Number : 325-643-3561
Fax Number : 325-646-0670
Provider Business Practice Location Address
First Line : 100 S PARK DR
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-5918
Country : US
Telephone Number : 325-643-3561
Fax Number : 325-646-0670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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