Provider Demographics
NPI:1952989758
Name:GASTRO MD ANESTHESIA, LLC
Entity Type:Organization
Organization Name:GASTRO MD ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFIER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-477-5580
Mailing Address - Street 1:511 W BAY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2700
Mailing Address - Country:US
Mailing Address - Phone:813-819-0309
Mailing Address - Fax:
Practice Address - Street 1:5016 W CYPRESS ST STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3804
Practice Address - Country:US
Practice Address - Phone:813-542-2586
Practice Address - Fax:813-281-1735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTRO MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty