Provider Demographics
NPI:1831129592
Name:SANFORD, CURTIS L II (CRNA)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:SANFORD
Suffix:II
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 1:2644 S. SHERWOOD FOREST BLVD.
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2248
Mailing Address - Country:US
Mailing Address - Phone:225-293-3587
Mailing Address - Fax:225-293-1807
Practice Address - Street 1:314 YOUNGSVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4524
Practice Address - Country:US
Practice Address - Phone:337-769-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1177407Medicaid
LA4C969Medicare ID - Type Unspecified