Individual
HAROLD RICHIE BANDALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 526-1068
(903) 593-4290
Mailing address
P.O. BOX 8027, TYLER, TX 75711-8027
(903) 526-1068
(903) 593-4290
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
671921
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141704005
—
TX
05
—
141704006
—
TX
01
—
86184U
BCBS OF TEXAS
TX
01
—
8649UA
BCBS
TX
01
—
P00288096
PART B RAILROAD MEDICARE
TX
Enumeration date
10/20/2006
Last updated
05/01/2013
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