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Individual

MR. JOHN EDWARD DULAVERIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
6402 LOST CREEK DR, TEXARKANA, TX 75503-0902
(979) 557-1555
Mailing address
6402 LOST CREEK DR, TEXARKANA, TX 75503-0902
(979) 557-1555

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
599388
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
599388
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
367500000X
TRICARE
GA
Enumeration date
02/15/2006
Last updated
10/02/2014
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