Individual
PAUL RICHARD ILLYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
700 LIVE OAK DR, ANESTHESIA DEPT., KILLEEN, TX 76541-7272
(501) 827-4968
Mailing address
700 LIVE OAK DR, KILLEEN, TX 76541-7272
(501) 827-4968
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
507123
TX
367500000X
Certified Registered Nurse Anesthetist
R0028011
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115061701
—
AR
Enumeration date
07/15/2006
Last updated
01/07/2013
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