Provider Demographics
NPI:1629193008
Name:JOHNS, BRUCE M (CRNA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:JOHNS
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 1:3645 FM 3349
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-5297
Mailing Address - Country:US
Mailing Address - Phone:512-784-8071
Mailing Address - Fax:
Practice Address - Street 1:3645 FM 3349
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-5297
Practice Address - Country:US
Practice Address - Phone:512-784-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX048678367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048678OtherCRNA ID#
TX048678OtherCRNA ID#