Basic Information
| Provider Information | |||||||||
| NPI: | 1790881183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE ANESTHESIA ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17347 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333187347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543701053 | ||||||||
| FaxNumber: | 9543701533 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 N UNIVERSITY DR FL 2 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542277760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | AARONS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543701053 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | CH1654 | 01 | FL | RAILROAD MEDICARE | OTHER |