Provider Demographics
NPI:1487093787
Name:JEFFREY B. SACK, M.D., P.A.
Entity type:Organization
Organization Name:JEFFREY B. SACK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-371-3800
Mailing Address - Street 1:5741 BEE RIDGE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5083
Mailing Address - Country:US
Mailing Address - Phone:941-371-3800
Mailing Address - Fax:941-371-2069
Practice Address - Street 1:5741 BEE RIDGE RD STE 260
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5083
Practice Address - Country:US
Practice Address - Phone:941-371-3800
Practice Address - Fax:941-371-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 56807207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty