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General NPI Number Information
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NPI Number | 1417604018
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 5611 SOLERA CT
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City | FORT MYERS
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State | FL
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Zip | 33919-3432
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Country | US
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Telephone | 941-882-0805
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Fax |
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Provider Business Mailing Address
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Address Line | 5611 SOLERA CT
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City | FORT MYERS
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State | FL
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Zip | 33919-3432
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Country | US
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Telephone | 239-339-7356
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. PAUL MARK BLOOMSTON
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Credential | MD
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Telephone | 239-339-7356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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