Healthcare Provider Details

I. General information

NPI: 1013522325
Provider Name (Legal Business Name): FLORIDA GULF COAST ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 N DAVIS HWY
PENSACOLA FL
32503-2339
US

IV. Provider business mailing address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

V. Phone/Fax

Practice location:
  • Phone: 850-696-4000
  • Fax:
Mailing address:
  • Phone: 205-977-1949
  • Fax: 334-377-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIM TRAN
Title or Position: MANAGER
Credential: MD
Phone: 818-970-8191