Provider Demographics
NPI:1932525797
Name:INDIAN RIVER SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:INDIAN RIVER SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-569-5660
Mailing Address - Street 1:3735 11TH CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4884
Mailing Address - Country:US
Mailing Address - Phone:772-569-5660
Mailing Address - Fax:772-569-4343
Practice Address - Street 1:3735 11TH CIR STE 101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4884
Practice Address - Country:US
Practice Address - Phone:772-569-5660
Practice Address - Fax:772-569-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty