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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