Individual
MR. JACK DONATHAN PRICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
650845
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1424954-01
—
TX
05
—
142495408
—
TX
01
—
8610UJ
BCBS
TX
01
—
P01446643
RR
TX
Enumeration date
10/19/2005
Last updated
06/23/2018
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