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Provider Information for 1932427820

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1932427820

Calendar   Last Updated:  2016-06-24
  Certification Date: 


Name Value
NPI 1932427820
Enumeration Date 2010-05-17
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 863407
ORLANDO, FL 32886-3407
United States

Phone: 941-917-2600 | Fax: 941-917-7884
View Map External Link
Primary Practice Address 1921 WALDEMERE ST SUITE 504
SARASOTA, FL 34239-2943
United States

Phone: 941-917-8525 | Fax: 941-917-8526
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BCBS FL 33181
Primary Taxonomy Selected Taxonomy State License Number
Yes 207X00000X - Orthopaedic Surgery FL 14907