Provider Demographics
NPI:1487382289
Name:INDIALANTIC ANESTHESIA SERVICES
Entity type:Organization
Organization Name:INDIALANTIC ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DURHAM
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-998-0887
Mailing Address - Street 1:870 N MIRAMAR AVE # 777
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3054
Mailing Address - Country:US
Mailing Address - Phone:831-998-0887
Mailing Address - Fax:321-204-6861
Practice Address - Street 1:95 BULLDOG BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3175
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:321-729-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty