MEDICARE: DEAN R LOSS 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	RN108812	GA
2	367500000X	Certified Registered Nurse Anesthetist	APN1388	SC

General Provider Information

NPI Number	:	1730179920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN R LOSS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 204097
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907
Country	:	US
Telephone Number	:	706-855-9860
Fax Number	:	706-860-7124

Provider Business Practice Location Address
First Line	:	3651 WHEELER RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6521
Country	:	US
Telephone Number	:	706-855-9860
Fax Number	:	706-860-7124

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	04/11/2011

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