Organization
WATERMAN ANESTHESIOLOGY GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS A OLIN MD (DIRECTOR)
(407) 667-0444
Entity
Organization
Contact information
Practice address
1000 WATERMAN WAY, TAVARES, FL 32778-5266
(352) 253-3765
(352) 253-3487
Mailing address
291 SOUTHHALL LN, SUITE 201, MAITLAND, FL 32751-7274
(407) 667-0444
(407) 667-4338
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBS
FL
05
—
PENDING
—
FL
Enumeration date
11/19/2012
Last updated
11/19/2012
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