Organization
IPS OF DELTONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL RICHARDSON NOBACK MD (PRESIDENT)
(941) 360-1566
Entity
Organization
Contact information
Practice address
777 DELTONA BLVD, SUITE 21, DELTONA, FL 32725-7173
(386) 575-2225
(386) 575-1096
Mailing address
201 MONTGOMERY AVE, SARASOTA, FL 34243-1519
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
03/09/2009
Last updated
03/09/2009
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