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General NPI Number Information
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NPI Number | 1841682713
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Entity Type | Organization
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Legal Business Name | AISTHESIS OF FLORIDA LLC
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 2222 SOUTH HARBOR CITY BLVD SUITE 540
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City | MELBOURNE
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State | FL
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Zip | 32901
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Country | US
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Telephone | 321-541-1776
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Fax | 301-986-8011
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Provider Business Mailing Address
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Address Line | 4330 EAST WEST HIGHWAY SUITE 1100
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City | BETHESDA
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State | MD
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Zip | 20814-4408
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Country | US
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Telephone | 301-986-8010
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Fax | 301-986-8011
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Authorized Official
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Title or Position | CEO
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Name | JOHN R WALTON
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Credential |
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Telephone | 301-986-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD33512
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101230517
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0055356
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License Number State | MD
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