Provider Demographics
NPI:1982412979
Name:MERAZ, ANTHONY ITHZAK (CRNA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ITHZAK
Last Name:MERAZ
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 1:305 W COMMERCE ST APT 474
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2075
Mailing Address - Country:US
Mailing Address - Phone:806-420-3069
Mailing Address - Fax:
Practice Address - Street 1:305 W COMMERCE ST APT 474
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2075
Practice Address - Country:US
Practice Address - Phone:806-420-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty