Provider Demographics
NPI:1164521902
Name:EDDY, WILLIAM LAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAYNE
Last Name:EDDY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 INTERNATIONAL PLZ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4820
Mailing Address - Country:US
Mailing Address - Phone:817-529-1923
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:2694 N GALLOWAY AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-681-2226
Practice Address - Fax:972-681-7838
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX053425367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49851Medicare UPIN
8D5578Medicare ID - Type Unspecified