Provider Demographics
NPI:1770761199
Name:SHIPP, JAMES REYNALDO (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:REYNALDO
Last Name:SHIPP
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:2417 COLORADO ST
Mailing Address - Street 2:APT #1107
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9589
Mailing Address - Country:US
Mailing Address - Phone:318-470-5064
Mailing Address - Fax:
Practice Address - Street 1:316 SANDPIPER AVE
Practice Address - Street 2:APT #1107
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-1760
Practice Address - Country:US
Practice Address - Phone:318-470-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX748784367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology