Provider Demographics
NPI:1700637121
Name:MJD ANESTHESIA PLLC
Entity Type:Organization
Organization Name:MJD ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DINOS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:845-313-0882
Mailing Address - Street 1:PO BOX 6696
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6696
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:
Practice Address - Street 1:1305 W PARK DR
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2366
Practice Address - Country:US
Practice Address - Phone:845-313-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty