Provider Demographics
NPI:1457450025
Name:BAUBLET, PETER W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:W
Last Name:BAUBLET
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 633281
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-3281
Mailing Address - Country:US
Mailing Address - Phone:936-560-6713
Mailing Address - Fax:936-559-1233
Practice Address - Street 1:1345 COUNTY ROAD 213
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-6862
Practice Address - Country:US
Practice Address - Phone:936-560-6713
Practice Address - Fax:936-559-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244941367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C49MMedicare ID - Type UnspecifiedSOLE PROPRIETORSHIP NUMBE