Provider Demographics
NPI:1174661367
Name:LOYLESS, JOHN P (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LOYLESS
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 1:1815 BUTTERFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-4427
Mailing Address - Country:US
Mailing Address - Phone:915-558-7376
Mailing Address - Fax:
Practice Address - Street 1:406 S GARY AVE
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4799
Practice Address - Country:US
Practice Address - Phone:432-943-2511
Practice Address - Fax:432-943-6833
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB21827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81591UOtherBLUE CROSS
TXR56320Medicare UPIN
TX80952HMedicare ID - Type UnspecifiedMEDICARE