Provider Demographics
NPI:1396017927
Name:ORGILL, ROBERT JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:ORGILL
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:BUREAU OF MEDICINE & SURGERY DETACHMENT JACKSONVILLE
Mailing Address - Street 2:NAS JACKSONVILLE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUREAU OF MEDICINE & SURGERY DETACHMENT JACKSONVILLE
Practice Address - Street 2:NAS JACKSONVILLE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:310-727-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773562171000000X
CA87803367500000X
GURE2249163W00000X
GUNP0166367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No171000000XOther Service ProvidersMilitary Health Care Provider
No163W00000XNursing Service ProvidersRegistered Nurse