Individual
MR. JEFFREY FRED DAVANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1501 E MOCKINGBIRD LN, 101, VICTORIA, TX 77904-2155
(361) 573-2481
(361) 576-2434
Mailing address
3719 COUNTY ROAD 131, WHARTON, TX 77488-8535
(713) 252-5200
(979) 563-1693
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
642422
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
642422
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052983
RECERTIFICATION
TX
05
—
151044802
—
TX
01
—
83842U
BLUE CROSS/BLUE SHIELD
TX
01
—
P00090293
RAILROAD MEDICARE
TX
Enumeration date
10/26/2005
Last updated
08/05/2016
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