Individual
MR. JERRY LEE BLISS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1800 E FLORENCE BLVD, CASA GRANDE, AZ 85122-5303
(520) 381-6300
Mailing address
2060 N 159TH AVE, GOODYEAR, AZ 85395-7580
(253) 686-7491
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
268733
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/03/2021
Last updated
02/18/2022
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