Provider Demographics
NPI:1306899349
Name:COLLIER ANESTHESIA PAIN LLC
Entity type:Organization
Organization Name:COLLIER ANESTHESIA PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-7375
Mailing Address - Street 1:PO BOX 638900
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8900
Mailing Address - Country:US
Mailing Address - Phone:239-939-7375
Mailing Address - Fax:239-939-5105
Practice Address - Street 1:4035 EVANS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9308
Practice Address - Country:US
Practice Address - Phone:239-939-7375
Practice Address - Fax:239-939-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94852OtherBLUE CROSS BLUE SHIELD
FL94852OtherBLUE CROSS BLUE SHIELD