Provider Demographics
NPI:1316934052
Name:OFFUTT, JOHN ALAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALAN
Last Name:OFFUTT
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 1:2403 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2618
Mailing Address - Country:US
Mailing Address - Phone:817-219-5656
Mailing Address - Fax:817-578-8880
Practice Address - Street 1:2403 PEBBLE DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2618
Practice Address - Country:US
Practice Address - Phone:817-578-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231449367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126053108Medicaid
TX88915UOtherBCBS
TX126053108Medicaid
TXTXB11549Medicare PIN