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General NPI Number Information
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NPI Number | 1750570792
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Entity Type | Organization
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Legal Business Name | STEVEN A VISNAW DO PA
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 11373 CORTEZ BLVD SUITE 202
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-796-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 11373 CORTEZ BLVD SUITE 202
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-796-2494
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Fax |
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. STEVEN AUSTIN VISNAW
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Credential | DO
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Telephone | 352-796-2494
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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 | OS9556
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License Number State | FL
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