Healthcare Provider Details

I. General information

NPI: 1730230764
Provider Name (Legal Business Name): EAR, NOSE, AND THROAT ASSOCIATES OF MANATEE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MANATEE AVE W SUITE 202
BRADENTON FL
34205-8604
US

IV. Provider business mailing address

701 MANATEE AVE W SUITE 202
BRADENTON FL
34205-8604
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2455
  • Fax: 941-750-9704
Mailing address:
  • Phone: 941-748-2455
  • Fax: 941-750-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME85106
License Number StateFL

VIII. Authorized Official

Name: MRS. JOAN OVERBY
Title or Position: ADMINISTRATOR
Credential: CMPE
Phone: 941-748-2455