Provider Demographics
NPI:1033172358
Name:CONATSER, EDGAR RAY (CRNA)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:RAY
Last Name:CONATSER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-567-4500
Mailing Address - Fax:210-567-0083
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-567-4500
Practice Address - Fax:210-567-0083
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN143173367500000X
TXAP117611367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100044405OtherPHP TENNCARE
TN3633336Medicaid
TN4075316OtherBLUECARE
TN4075316OtherBLUE CROSS
TN3633336Medicaid