Provider Demographics
NPI:1801855176
Name:PHLEGAR, PATRICK JON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JON
Last Name:PHLEGAR
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 1:914 TAIRILIN DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4915
Mailing Address - Country:US
Mailing Address - Phone:843-628-0779
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 17 BYPASS
Practice Address - Street 2:WACCAMAW COMMUNITY HOSPITAL
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-652-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2124367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1338Medicaid
SCAN1338Medicaid