Provider Demographics
NPI:1740461052
Name:EDWARD J. FLISS, JR., PA
Entity type:Organization
Organization Name:EDWARD J. FLISS, JR., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FLISS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:941-351-3466
Mailing Address - Street 1:7425 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-1808
Mailing Address - Country:US
Mailing Address - Phone:941-351-3466
Mailing Address - Fax:941-351-3639
Practice Address - Street 1:7425 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1808
Practice Address - Country:US
Practice Address - Phone:941-351-3466
Practice Address - Fax:941-351-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70066ZOtherBCBS
FL88968ZOtherBCBS
FLT96764Medicare UPIN
FL88968ZMedicare PIN
FL70066ZOtherBCBS
FL70066ZMedicare PIN