MEDICARE: MR. JOHN MADISON CARY SR. 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	693338	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00059390	OTHER	TX	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	83216U	OTHER	TX	BCBS
5	8937UB	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1790762193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MADISON CARY SR. CRNA

Provider Business Mailing Address
First Line	:	4344 FAIRFAX AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3027
Country	:	US
Telephone Number	:	214-557-5597
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 FAIRFAX AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3027
Country	:	US
Telephone Number	:	214-557-5597
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	10/24/2015

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Directions to “ MR. JOHN MADISON CARY SR. CRNA” Practice Location

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