# WATERSIDE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518205038
- **Authorized official:** MATTHEW L BLACK M.D. (MANAGER)
- **Authorized official phone:** (239) 293-4140

## Contact information

- **Practice address:** 311 9TH ST N, NAPLES, FL 34102-5885
- **Practice address phone:** (239) 293-4140
- **Practice address fax:** (239) 254-3105
- **Mailing address:** 5064 SEASHELL AVE, NAPLES, FL 34103-2428
- **Mailing address phone:** (239) 293-4140
- **Mailing address fax:** (239) 254-3105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | M80046 | FL | Yes |

## Other

- **Enumeration date:** 01/17/2013
- **Last updated:** 08/22/2013