Provider Demographics
NPI:1376568402
Name:LIESER, JAMES T (CRNA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:T
Last Name:LIESER
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2021008240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO831100042Medicaid
MO831100042Medicaid
MO831100042Medicaid
MOP00331017Medicare PIN