Healthcare Provider Details

I. General information

NPI: 1083665426
Provider Name (Legal Business Name): FLORIDA GULF-TO-BAY ANESTHESIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CIRCLE FRONT DR
EVANSVILLE IN
47715-7196
US

IV. Provider business mailing address

809 S ALBANY AVE
TAMPA FL
33606-2407
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. DEVANAND MANGAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-844-4396