Individual
THEODORE DARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6122
(864) 560-6276
Mailing address
PO BOX 651602, CHARLOTTE, NC 28265-1602
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
204898
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052453
—
NC
05
—
NAN588
—
SC
01
—
P00729167
RAILROAD MEDICARE
SC
Enumeration date
06/05/2006
Last updated
10/27/2020
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