Provider Demographics
NPI:1942428677
Name:MIDDLETON, RICHARD GERRY (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GERRY
Last Name:MIDDLETON
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 1:2700 WAYNE MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9459
Mailing Address - Country:US
Mailing Address - Phone:919-731-6142
Mailing Address - Fax:919-731-6966
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9459
Practice Address - Country:US
Practice Address - Phone:919-731-6068
Practice Address - Fax:919-731-6025
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052817Medicaid
NCP00406464OtherRAILROAD-MEDICARE
NCP00406464OtherRAILROAD-MEDICARE