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Individual
MR. TERRY DEAN BOATMAN
Active
Individual
MR. TERRY DEAN BOATMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
657228
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143828501
—
TX
01
—
81648U
BLUE CROSS BLUE SHEILD
TX
Enumeration date
01/29/2007
Last updated
07/08/2007
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