Provider Demographics
NPI:1730100488
Name:WHITE SANDS ANESTHESIA & PAIN MEDICINE INC
Entity Type:Organization
Organization Name:WHITE SANDS ANESTHESIA & PAIN MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZWINGELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-872-0303
Mailing Address - Street 1:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-1968
Mailing Address - Country:US
Mailing Address - Phone:850-872-0303
Mailing Address - Fax:850-872-0305
Practice Address - Street 1:2338 STATE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4361
Practice Address - Country:US
Practice Address - Phone:850-872-0303
Practice Address - Fax:850-872-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36522207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03579AOtherBCBS FL
FLK7757Medicare ID - Type Unspecified