Provider Demographics
NPI:1053346593
Name:BEISSER, PAUL T III (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:BEISSER
Suffix:III
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:P.O. BOX 1492
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:WY
Mailing Address - Zip Code:82513-1492
Mailing Address - Country:US
Mailing Address - Phone:208-351-2887
Mailing Address - Fax:
Practice Address - Street 1:1492 BOX
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513-1492
Practice Address - Country:US
Practice Address - Phone:208-351-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY50101207L00000X
IDN-31082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806421302Medicaid