Provider Demographics
NPI:1265626071
Name:AILLES, ALAN DALE (CRNA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:AILLES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5607
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:5010 CRENSHAW RD.
Practice Address - Street 2:STE. #130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046CCOtherRPK MEDICARE GROUP #
TXTXB121124Medicare PIN
TX8K3306Medicare PIN