Healthcare Provider Details
I. General information
NPI: 1851937593
Provider Name (Legal Business Name): ANESTHESIA PROVIDERS OF FORT MYERS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/18/2019
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8380 RIVERWALK PARK BLVD STE 220
FORT MYERS FL
33919-8758
US
IV. Provider business mailing address
13181 PONDEROSA WAY
FORT MYERS FL
33907-7821
US
V. Phone/Fax
- Phone: 239-215-4104
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 367500000X |
| Taxonomy | Certified Registered Nurse Anesthetist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DAVID
M
GUTSTEIN
Title or Position: CEO
Credential: MD
Phone: 239-466-8838