Organization
SOUTHWEST FLORIDA ANESTHESIA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA M. WATERHOUSE (EXECUTIVE DIRECTOR)
(239) 261-1158
Entity
Organization
Contact information
Practice address
1336 CREEKSIDE BLVD, SUITE 1, NAPLES, FL 34108-1931
(239) 261-1158
(239) 261-4232
Mailing address
PO BOX 198044, ATLANTA, GA 30384-8044
(239) 261-1158
(239) 261-4232
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000CD
BLUE CROSS BLUE SHIELD OF FL
FL
Enumeration date
10/01/2009
Last updated
01/26/2010
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