Provider Demographics
NPI:1467481747
Name:ADVANCED SURGICAL ASSOCIATES OF WEST FL LLP
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES OF WEST FL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-586-3751
Mailing Address - Street 1:1258 W BAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2242
Mailing Address - Country:US
Mailing Address - Phone:727-586-3751
Mailing Address - Fax:727-584-3102
Practice Address - Street 1:1258 W BAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2242
Practice Address - Country:US
Practice Address - Phone:727-586-3751
Practice Address - Fax:727-584-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty