Healthcare Provider Details

I. General information

NPI: 1184292815
Provider Name (Legal Business Name): ANESTHESIA DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204B E 19TH ST
PANAMA CITY FL
32405-4707
US

IV. Provider business mailing address

LB #8247 PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 240-469-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA G ADKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 240-469-2181