Provider Demographics
NPI:1316362536
Name:BLUE WATER SURGICAL, PLLC
Entity Type:Organization
Organization Name:BLUE WATER SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-634-4038
Mailing Address - Street 1:7062 S ALOYSIA AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34436-2844
Mailing Address - Country:US
Mailing Address - Phone:352-634-4038
Mailing Address - Fax:
Practice Address - Street 1:7062 S ALOYSIA AVE
Practice Address - Street 2:
Practice Address - City:FLORAL CITY
Practice Address - State:FL
Practice Address - Zip Code:34436-2844
Practice Address - Country:US
Practice Address - Phone:352-634-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty