Healthcare Provider Details

I. General information

NPI: 1962766576
Provider Name (Legal Business Name): SARASOTA ORTHOPEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 UNIVERSITY PKWY SUITE 203
LAKEWOOD RANCH FL
34240-8604
US

IV. Provider business mailing address

2750 BAHIA VISTA ST SUITE 100
SARASOTA FL
34239-2600
US

V. Phone/Fax

Practice location:
  • Phone: 941-951-2663
  • Fax: 941-957-4437
Mailing address:
  • Phone: 941-951-2663
  • Fax: 941-957-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL GORDON
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 941-951-2663