Healthcare Provider Details

I. General information

NPI: 1760740781
Provider Name (Legal Business Name): GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 INDIAN ROCKS RD S
LARGO FL
33774-1035
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY SUITE 203
KNOXVILLE TN
37919-4052
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4396
  • Fax: 813-844-4972
Mailing address:
  • Phone: 813-844-4434
  • Fax: 813-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEVANAND MANGAR
Title or Position: PRESIDENT
Credential: MD
Phone: 813-844-4434