Provider Demographics
NPI:1033358544
Name:DEMOURA, MARCOS D (CRNA)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:D
Last Name:DEMOURA
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 1:3717 GLEN ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7862
Mailing Address - Country:US
Mailing Address - Phone:423-741-9464
Mailing Address - Fax:
Practice Address - Street 1:818 SUNSET DR STE 103
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8310
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered