Organization
BAYSHORE ANESTHESIA P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARTHUR PAUL BROADERICK MD (MD/PRESIDENT)
(352) 867-8898
Entity
Organization
Contact information
Practice address
2190 HIGHWAY 85 N, NICEVILLE, FL 32578-1045
(352) 867-8898
(352) 732-6282
Mailing address
PO BOX 7419, ORLANDO, FL 32891-7419
(352) 867-8898
(352) 732-6282
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME69348
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28253
BLUE CROSS BLUE SHIELD
FL
05
—
379870400
—
FL
Enumeration date
09/16/2006
Last updated
08/09/2011
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