Provider Demographics
NPI:1982715025
Name:DOUGLASS, DALE AMASON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:AMASON
Last Name:DOUGLASS
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CRDAMC 36000 DARNALL LOOP
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8570
Practice Address - Fax:254-288-8975
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXRN231444367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered