Provider Demographics
NPI:1174511539
Name:UNDERWOOD, DONALD WESLEY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WESLEY
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:950 PARKMONT CIR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-4346
Mailing Address - Country:US
Mailing Address - Phone:251-343-4329
Mailing Address - Fax:251-343-3222
Practice Address - Street 1:125 GANDY HILL RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-7771
Practice Address - Country:US
Practice Address - Phone:229-246-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-029896367500000X
GARN103245367500000X
FLARNP3042242367500000X
TX616589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered