Basic Information
Provider Information
NPI: 1134754047
EntityType: 2
ReplacementNPI:  
OrganizationName: EXPERT ANESTHESIA SERVICES
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Mailing Information
Address1: PO BOX 1889
Address2:  
City: MUNCIE
State: IN
PostalCode: 473081889
CountryCode: US
TelephoneNumber: 7652840493
FaxNumber: 7652842434
Practice Location
Address1: 9726 TOUCHTON RD STE 305
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322468307
CountryCode: US
TelephoneNumber: 9046866020
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Other Information
ProviderEnumerationDate: 03/11/2020
LastUpdateDate: 03/11/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: RACHMAN
AuthorizedOfficialFirstName: NATHAN
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AuthorizedOfficialTitleorPosition: OWNER/AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 3864512975
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 03/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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