Basic Information
| Provider Information | |||||||||
| NPI: | 1093977803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINECREST ANESTHESIA ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550421 | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333550421 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7875 SW 104TH ST | ||||||||
| Address2: | SUITE # 201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331562677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | GOLD | ||||||||
| AuthorizedOfficialFirstName: | LEWIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.