MEDICARE: BLUE WATER SURGICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1316362536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATER SURGICAL, PLLC

Provider Business Mailing Address
First Line	:	7062 S ALOYSIA AVE
Second Line	:
City	:	FLORAL CITY
State	:	FL
Zip	:	34436-2844
Country	:	US
Telephone Number	:	352-634-4038
Fax Number	:

Provider Business Practice Location Address
First Line	:	7062 S ALOYSIA AVE
Second Line	:
City	:	FLORAL CITY
State	:	FL
Zip	:	34436-2844
Country	:	US
Telephone Number	:	352-634-4038
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. LARRY R FERBER
Credential	:	MD
Telephone Number	:	352-634-4038

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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