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General NPI Number Information
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NPI Number | 1750892121
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Entity Type | Organization
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Legal Business Name | ANESTHESIA OF INDIAN RIVER, INC.
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 772-567-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 873 RYANWOOD DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33413-1138
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Country | US
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Telephone | 561-632-4239
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Fax |
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Authorized Official
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Title or Position | ANESTHESIOLOGIST
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Name | DR. DONALD PORTELL
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Credential | MD
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Telephone | 772-778-9621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA425
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License Number State | FL
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