Provider Demographics
NPI:1518056134
Name:VESELY, GARY EDDIE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDDIE
Last Name:VESELY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:10541 W THUNDERBIRD BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3006
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0010367500000X
AZ034999367500000X
CA1813367500000X
AZRN075834367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ144923Medicaid
AZZ141487Medicare PIN
AZ70208Medicare ID - Type Unspecified
AZ144923Medicaid