Organization
WATERSIDE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW L BLACK M.D. (MANAGER)
(239) 293-4140
Entity
Organization
Contact information
Practice address
311 9TH ST N, NAPLES, FL 34102-5885
(239) 293-4140
(239) 254-3105
Mailing address
5064 SEASHELL AVE, NAPLES, FL 34103-2428
(239) 293-4140
(239) 254-3105
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
M80046
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HG441A
MEDICARE 855-B
FL
Enumeration date
01/17/2013
Last updated
08/22/2013
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