Provider Demographics
NPI:1790762193
Name:CARY, JOHN MADISON SR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MADISON
Last Name:CARY
Suffix:SR
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 1:4344 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3027
Mailing Address - Country:US
Mailing Address - Phone:214-557-5597
Mailing Address - Fax:
Practice Address - Street 1:4344 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3027
Practice Address - Country:US
Practice Address - Phone:214-557-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00059390OtherRAILROAD
TX1572273-04Medicaid
TX157227302Medicaid
TX83216UOtherBCBS
TX8937UBOtherBCBSTX
TX157227302Medicaid
TX8L19129Medicare PIN
TX1572273-04Medicaid