Provider Demographics
NPI:1376531467
Name:WYTHE, GERALD T (CRNA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:T
Last Name:WYTHE
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 1:7900 FANNIN ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2900
Mailing Address - Country:US
Mailing Address - Phone:713-790-1349
Mailing Address - Fax:713-790-0028
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2900
Practice Address - Country:US
Practice Address - Phone:713-790-1349
Practice Address - Fax:713-790-0028
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX051619367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83708UOtherBLUE CROSS BLUE SHIELD
TX81638HMedicare PIN