Provider Demographics
NPI: | 1003040502 |
---|---|
Name: | SYNERGY ANESTHESIOLOGY INC |
Entity Type: | Organization |
Organization Name: | SYNERGY ANESTHESIOLOGY INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DOUBERLY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 941-360-1566 |
Mailing Address - Street 1: | PO BOX 850001 PO BOX 850001 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32885-4380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 941-360-1566 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4080 MCGINNIS FERRY RD |
Practice Address - Street 2: | STE 102 |
Practice Address - City: | ALPHARETTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30005-3948 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-360-1566 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-12 |
Last Update Date: | 2022-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |