Organization
SURGICAL PHYSICIAN ASSISTANTS LLC
Active
Organization
SURGICAL PHYSICIAN ASSISTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN MICHAEL JANKE PA-C (OWNER)
(321) 615-4800
Entity
Organization
Contact information
Practice address
205 PLATT AVE, MERRITT ISLAND, FL 32952-4963
(321) 615-4800
(321) 574-0590
Mailing address
PO BOX 362, COCOA, FL 32923-0362
(321) 615-4800
(321) 574-0590
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 9102122
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K9613
MEDICARE GROUP ID #
FL
Enumeration date
08/27/2006
Last updated
12/08/2010
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