Provider Demographics
NPI:1679576755
Name:KLAPPHOLZ, DAVID L (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KLAPPHOLZ
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 2626
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2626
Mailing Address - Country:US
Mailing Address - Phone:877-294-7444
Mailing Address - Fax:817-294-7172
Practice Address - Street 1:12804 PECOS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-0884
Practice Address - Country:US
Practice Address - Phone:865-385-9043
Practice Address - Fax:865-671-4947
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4047367500000X
TX637070367500000X
TN000010225367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00663775OtherRAILROAD MEDICARE
4162600OtherBCBS
TNP00663775OtherRAILROAD MEDICARE
SCQ354989477Medicare PIN