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General NPI Number Information
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NPI Number | 1720214836
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Entity Type | Organization
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Legal Business Name | MUA PHYSICIANS OF NAPLES LLC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 3467 PINE RIDGE RD SUITE 102
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City | NAPLES
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State | FL
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Zip | 34109-3832
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Country | US
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Telephone | 239-592-5367
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Fax | 239-592-5048
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Provider Business Mailing Address
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Address Line | 3467 PINE RIDGE RD SUITE 102
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City | NAPLES
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State | FL
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Zip | 34109-3832
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Country | US
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Telephone | 239-592-5367
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Fax | 239-592-5048
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW BLACK
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Credential | MD
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Telephone | 239-592-5367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | BB4722244
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License Number State | FL
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