MEDICARE: ROLAND REESE DAIGLE 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	512552	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84893U	OTHER	TX	BCBSTX
2	88726U	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891798781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLAND REESE DAIGLE CRNA

Provider Business Mailing Address
First Line	:	1105 E GOLIAD AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-2230
Country	:	US
Telephone Number	:	936-544-4996
Fax Number	:	936-544-4244

Provider Business Practice Location Address
First Line	:	1105 E GOLIAD AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-2230
Country	:	US
Telephone Number	:	936-544-4996
Fax Number	:	936-544-4244

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/20/2009

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Directions to “ ROLAND REESE DAIGLE CRNA” Practice Location

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