Provider Demographics
NPI:1992753941
Name:WEST FLORIDA ANESTHESIA CONSULTANTS, PA
Entity type:Organization
Organization Name:WEST FLORIDA ANESTHESIA CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEFREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-798-3524
Mailing Address - Street 1:PO BOX 30289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33630-3289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:STE 4650
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4608
Practice Address - Country:US
Practice Address - Phone:941-798-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063724600Medicaid
00894Medicare PIN