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General NPI Number Information
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NPI Number | 1730230764
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Entity Type | Organization
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Legal Business Name | EAR, NOSE, AND THROAT ASSOCIATES OF MANATEE, PA
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 701 MANATEE AVE W SUITE 202
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City | BRADENTON
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State | FL
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Zip | 34205-8604
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Country | US
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Telephone | 941-748-2455
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Fax | 941-750-9704
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Provider Business Mailing Address
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Address Line | 701 MANATEE AVE W SUITE 202
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City | BRADENTON
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State | FL
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Zip | 34205-8604
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Country | US
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Telephone | 941-748-2455
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Fax | 941-750-9704
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JOAN OVERBY
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Credential | CMPE
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Telephone | 941-748-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME85106
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License Number State | FL
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