Individual
LARRY JEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA RRT
Contact information
Practice address
500 N HIGHLAND AVE, SHERMAN, TX 75092-7354
(903) 891-7000
(903) 893-5334
Mailing address
119 W HOUSTON ST, SHERMAN, TX 75090-5909
(903) 891-7000
(903) 893-5334
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
24291
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
566292
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130161603
—
TX
01
—
430028470
RAILROAD MEDICARE
TX
01
—
86720C
BLUE CROSS BLUE SHIELD
TX
01
—
89624U
BCBS (PINNACLE)
TX
Enumeration date
07/04/2006
Last updated
02/20/2009
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