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Organization
MANATEE PHYSICIAN ALLIANCE, LLC
Active
Organization
MANATEE PHYSICIAN ALLIANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
206 2ND ST E, BRADENTON, FL 34208-1042
(941) 745-7207
Mailing address
367 S GULPH RD, KING OF PRUSSIA, PA 19406-3121
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
ME87766
FL
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016Z
BCBS
FL
05
—
002733000
—
FL
01
—
7971452
CIGNA
FL
01
—
DQ9845
MEDICARE RR
FL
Enumeration date
08/28/2010
Last updated
06/26/2019
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