Healthcare Provider Details

I. General information

NPI: 1124403191
Provider Name (Legal Business Name): MID-FLORIDA ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 GLADES RD SUITE 5-A
BOCA RATON FL
33431-6401
US

IV. Provider business mailing address

7100 W CAMINO REAL SUITE 301
BOCA RATON FL
33433-5510
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-7676
  • Fax: 772-337-9034
Mailing address:
  • Phone: 561-465-2598
  • Fax: 561-465-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: JAY MARTIN
Title or Position: CEO
Credential:
Phone: 561-465-2598