MEDICARE: GULFCOAST ANESTHESIOLOGY PA

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	207L00000X	Anesthesiology Physician	ME59242	FL

General Provider Information

NPI Number	:	1457488611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFCOAST ANESTHESIOLOGY PA

Provider Business Mailing Address
First Line	:	4947 CLARK RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3252
Country	:	US
Telephone Number	:	941-926-0969
Fax Number	:	941-923-1281

Provider Business Practice Location Address
First Line	:	4947 CLARK RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3252
Country	:	US
Telephone Number	:	941-926-0969
Fax Number	:	941-923-1281

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MRS. GAIL S LAMB
Credential	:
Telephone Number	:	941-926-0969

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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