Provider Demographics
NPI:1386789642
Name:DEINDOERFER, RICHARD D (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:DEINDOERFER
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 1:82 PATTON AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3319
Mailing Address - Country:US
Mailing Address - Phone:828-398-5222
Mailing Address - Fax:828-398-5223
Practice Address - Street 1:82 PATTON AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3319
Practice Address - Country:US
Practice Address - Phone:828-398-5222
Practice Address - Fax:828-398-5223
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9103367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3600382Medicaid
TN0095409OtherBLUE CROSS BLUE SHIELD