Organization
ST LUCIE SURGICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN ANTHONY CONCILIO M.D. (OWNER/PHYSICIAN)
(772) 873-8501
Entity
Organization
Contact information
Practice address
8483 S US HIGHWAY 1, SUITE 19, PORT ST LUCIE, FL 34952-3360
(772) 873-8501
(772) 873-8516
Mailing address
PO BOX 7665, PORT ST LUCIE, FL 34985-7665
(772) 873-8501
(772) 873-8516
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
Other
Enumeration date
08/25/2008
Last updated
09/30/2008
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