MEDICARE: MR. ANTHONY ITHZAK MERAZ 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	152608	TX

General Provider Information

NPI Number	:	1982412979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY ITHZAK MERAZ CRNA

Provider Business Mailing Address
First Line	:	305 W COMMERCE ST APT 474
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2075
Country	:	US
Telephone Number	:	806-420-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W COMMERCE ST APT 474
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2075
Country	:	US
Telephone Number	:	806-420-3069
Fax Number	:

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

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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