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General NPI Number Information
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NPI Number | 1932198876
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Entity Type | Organization
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Legal Business Name | BRADENTON SURGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 5601 21ST AVE W SUITE D
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City | BRADENTON
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State | FL
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Zip | 34209-5642
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Country | US
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Telephone | 941-748-1471
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Fax | 941-748-6195
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Provider Business Mailing Address
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Address Line | 5601 21ST AVE W SUITE D
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City | BRADENTON
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State | FL
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Zip | 34209-5642
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Country | US
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Telephone | 941-748-1471
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Fax | 941-748-6195
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CYNTHIA TINKHAM
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Credential |
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Telephone | 941-748-1471
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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 |
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License Number State |
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