Organization
BON IMAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NARENDRA S SASTRY M.D. (MANAGER)
(813) 786-0322
Entity
Organization
Contact information
Practice address
15439 CORTEZ BLVD, BROOKSVILLE, FL 34613-6113
(352) 593-4194
(352) 593-5828
Mailing address
15439 CORTEZ BLVD, BROOKSVILLE, FL 34613-6113
(352) 593-4194
(352) 593-5828
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME63006
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006434900
—
FL
05
—
064781100
—
FL
05
—
371150100
—
FL
Enumeration date
01/20/2012
Last updated
05/05/2014
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