Healthcare Provider Details

I. General information

NPI: 1871531293
Provider Name (Legal Business Name): DELAND ANESTHESIOLOGY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PLYMOUTH AVE
DELAND FL
32720-3236
US

IV. Provider business mailing address

291 SOUTHHALL LN SUITE 201
MAITLAND FL
32751-7274
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-0444
  • Fax: 407-667-4338
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: EDMUNDO DELGADO
Title or Position: OFFICER OF DELAND ANESTHESIOLOGY
Credential: DO
Phone: 407-667-0444