Healthcare Provider Details

I. General information

NPI: 1356544605
Provider Name (Legal Business Name): BARBARA SRUR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S OSPREY AVE
SARASOTA FL
34239-2929
US

IV. Provider business mailing address

1625 S OSPREY AVE
SARASOTA FL
34239-2929
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-1463
  • Fax: 941-917-7543
Mailing address:
  • Phone: 941-917-1463
  • Fax: 941-917-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME53423
License Number StateFL

VIII. Authorized Official

Name: MISS PAMELA G BUTLER
Title or Position: COMPLIANCE SPECIALIST
Credential: CPC, CCP-P, CNA
Phone: 941-917-8345