Basic Information
| Provider Information | |||||||||
| NPI: | 1902125958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA ANESTHESIA SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850001 DEPT 0849 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774790450 | ||||||||
| FaxNumber: | 8666652702 | ||||||||
| Practice Location | |||||||||
| Address1: | 6043 WINTHROP COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335784272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774790450 | ||||||||
| FaxNumber: | 8666652702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 03/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | HERN | ||||||||
| AuthorizedOfficialFirstName: | DEDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8774790450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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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.