Healthcare Provider Details

I. General information

NPI: 1184648792
Provider Name (Legal Business Name): MELBOURNE ANESTHESIA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 MEDICAL PARK DR SUITE 101
MELBOURNE FL
32901-3246
US

IV. Provider business mailing address

10830 S TROPICAL TRL
MERRITT ISLAND FL
32952-7013
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-9493
  • Fax:
Mailing address:
  • Phone: 321-729-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 58208
License Number StateFL

VIII. Authorized Official

Name: DR. ERIC H KATZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 321-729-9493