Provider Demographics
NPI:1235121971
Name:DEVLIN, RAYMOND JAMES III (MSN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JAMES
Last Name:DEVLIN
Suffix:III
Gender:M
Credentials:MSN, CRNA
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:JAMES
Other - Last Name:DEVLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, CRNA
Mailing Address - Street 1:16513 HOWARD ST
Mailing Address - Street 2:APT D
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-2535
Mailing Address - Country:US
Mailing Address - Phone:337-537-5375
Mailing Address - Fax:
Practice Address - Street 1:16513 HOWARD ST
Practice Address - Street 2:APT D
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-2535
Practice Address - Country:US
Practice Address - Phone:337-537-5375
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094909APO04479367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered