Basic Information
| Provider Information | |||||||||
| NPI: | 1164460143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER OBGYN ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1767 LAKEWOOD RANCH BLVD # 233 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342114906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455115 | ||||||||
| FaxNumber: | 9415671000 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 4TH AVENUE CIR E | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342085623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455115 | ||||||||
| FaxNumber: | 9415671000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 03/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | SUDBURY | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9417455115 | ||||||||
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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 | 207V00000X | ME89915 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.