Individual
MR. JUSTIN GADDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
151866
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75-0818167-015
TRICARE
TX
01
—
8305UE
BCBS
TX
01
—
P01200603
RAIL ROAD
TX
Enumeration date
01/07/2013
Last updated
10/13/2014
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