Healthcare Provider Details

I. General information

NPI: 1407957871
Provider Name (Legal Business Name): VASCULAR SPECIALIST OF VENICE AND SARASOTA PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N. CATTLEMEN RD. SUITE 100
SARASOTA FL
34232-6410
US

IV. Provider business mailing address

600 N CATTLEMEN RD SUITE 100
SARASOTA FL
34232-6422
US

V. Phone/Fax

Practice location:
  • Phone: 941-378-3231
  • Fax: 941-378-3253
Mailing address:
  • Phone: 941-378-3231
  • Fax: 941-378-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME63973
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME119376
License Number StateFL

VIII. Authorized Official

Name: GERALD EDMUND GRUBBS
Title or Position: OWNER
Credential: MD
Phone: 941-378-3231