Organization
IPS OF PUNTA GORDA LLC
Active
Organization
IPS OF PUNTA GORDA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R. NOBACK MD (AUTHORIZED OFFICIAL)
(941) 360-1566
Entity
Organization
Contact information
Practice address
1400 EDUCATION WAY, PT CHARLOTTE, FL 33948-1000
(941) 625-9800
(941) 625-3492
Mailing address
PO BOX 864483, ORLANDO, FL 32886-4483
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
09/02/2009
Last updated
12/10/2009
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