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General NPI Number Information
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NPI Number | 1790752863
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Entity Type | Organization
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Legal Business Name | INVERNESS SURGICAL ASSOCIATION P A
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 403 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4717
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Country | US
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Telephone | 352-726-3646
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Fax | 352-726-0079
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Provider Business Mailing Address
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Address Line | 403 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4717
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Country | US
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Telephone | 352-726-3646
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Fax | 352-726-0079
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Authorized Official
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Title or Position | OFFICER/SECRETARY
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Name | MARC E FERNANDEZ
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Credential | M.D.
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Telephone | 352-726-3646
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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 | 80110207817
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License Number State | FL
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