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GAVIN VANCE BRUNEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2555 JIMMY JOHNSON BLVD, PORT ARTHUR, TX 77640-2007
(409) 853-5972
(337) 433-9861
Mailing address
PO BOX 3084, LAKE CHARLES, LA 70602-3084
(409) 853-5972
(337) 433-9861

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
520928
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
109774301
TX
Enumeration date
07/29/2006
Last updated
11/20/2008
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