Provider Demographics
NPI:1518576941
Name:FLORIDA INDEPENDENT MEDICAL AND SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:FLORIDA INDEPENDENT MEDICAL AND SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VALDIS
Authorized Official - Last Name:ZUDANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-299-1404
Mailing Address - Street 1:311 BAREFOOT BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:BAREFOOT BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7480
Mailing Address - Country:US
Mailing Address - Phone:772-212-1562
Mailing Address - Fax:
Practice Address - Street 1:311 BAREFOOT BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7480
Practice Address - Country:US
Practice Address - Phone:321-204-3747
Practice Address - Fax:772-318-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty