Provider Demographics
NPI:1972592707
Name:BELMONT III, ANTHONY M III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:BELMONT III
Suffix:III
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 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435
Mailing Address - Country:US
Mailing Address - Phone:307-754-2267
Mailing Address - Fax:307-754-7740
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-754-2267
Practice Address - Fax:307-754-7740
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC001480367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155719701Medicaid
P00191830OtherRR MEDICARE GROUP CK6327
AR5Y200OtherBCBS OF AR
AR5Y200C752Medicare PIN
AR5Y200Medicare PIN