Provider Demographics
NPI:1700883188
Name:STANGE, DAVID WARD (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WARD
Last Name:STANGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5138
Mailing Address - Country:US
Mailing Address - Phone:903-892-3282
Mailing Address - Fax:903-813-1872
Practice Address - Street 1:1303 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5138
Practice Address - Country:US
Practice Address - Phone:903-892-3282
Practice Address - Fax:903-813-1872
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX039489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109789104Medicaid
TXR57338Medicare UPIN
TX109789104Medicaid