Healthcare Provider Details

I. General information

NPI: 1497082655
Provider Name (Legal Business Name): GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11906 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

809 S ALBANY AVE
TAMPA FL
33606-2407
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2273
  • Fax: 813-253-2279
Mailing address:
  • Phone: 813-844-4396
  • Fax: 813-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

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