Provider Demographics
NPI:1619966694
Name:MEDICAL ANESTHESIA AND PAIN MANAGEMENT CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:MEDICAL ANESTHESIA AND PAIN MANAGEMENT CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MDA
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:GEZZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-332-5344
Mailing Address - Street 1:4048 EVANS AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9322
Mailing Address - Country:US
Mailing Address - Phone:239-332-5344
Mailing Address - Fax:239-332-7246
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9322
Practice Address - Country:US
Practice Address - Phone:239-332-5344
Practice Address - Fax:239-332-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058967207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043420500Medicaid
FL00550OtherBCBS
FL043420500Medicaid