Provider Demographics
NPI:1720185820
Name:VANVOORHIS, DAVID L (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:VANVOORHIS
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 67
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-0067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2411 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4817
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527431367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00796096OtherMEDICARE RAILROAD
TX090102703Medicaid
TX85276UOtherBLUE CROSS
TX090102704Medicaid
TX090102705Medicaid
TXP00394531OtherRAILROAD - MEDICARE
TX090102706Medicaid
TX88905UOtherBLUE CROSS ID - NORTH CYPRESS ANESTHESIOLOGY ASSOC.
TX8K8161Medicare PIN
TXP00796096OtherMEDICARE RAILROAD
TX090102703Medicaid
P00394531Medicare PIN