Provider Demographics
NPI:1164460143
Name:PREMIER OBGYN ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PREMIER OBGYN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SUDBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-745-5115
Mailing Address - Street 1:1767 LAKEWOOD RANCH BLVD # 233
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4906
Mailing Address - Country:US
Mailing Address - Phone:941-745-5115
Mailing Address - Fax:941-567-1000
Practice Address - Street 1:5323 4TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5623
Practice Address - Country:US
Practice Address - Phone:941-745-5115
Practice Address - Fax:941-567-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty