Provider Demographics
NPI:1275561359
Name:DAUZART, JAMES D JR (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:DAUZART
Suffix:JR
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:PO BOX 20452
Mailing Address - Street 2:YPS-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:1100 ANDRE ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:225-229-3407
Practice Address - Fax:337-330-2245
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02556367500000X
TX591952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1926434Medicaid
TX003476106Medicaid
TX1275561359OtherBCBS TX
LA1275561359OtherBCBS LA
TX003476103Medicaid
TX1275561359OtherBCBS TX
LA1275561359OtherBCBS LA
TXTXB137982Medicare PIN
LA4B768CW36Medicare PIN