Provider Demographics
NPI:1407828858
Name:DESZELL, DOUGLAS JAMES (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:DESZELL
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:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32345-0286
Mailing Address - Country:US
Mailing Address - Phone:850-673-1001
Mailing Address - Fax:850-997-6076
Practice Address - Street 1:75 E 5TH CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-5201
Practice Address - Country:US
Practice Address - Phone:850-673-1001
Practice Address - Fax:850-997-6076
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1453122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304031300Medicaid
FLG0085Medicare ID - Type Unspecified