Provider Demographics
NPI:1649640822
Name:FLORIDA ANESTHESIA CONSULTANTS
Entity type:Organization
Organization Name:FLORIDA ANESTHESIA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-894-1127
Mailing Address - Street 1:511 SE 5TH AVE APT 1901
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2978
Mailing Address - Country:US
Mailing Address - Phone:847-894-1127
Mailing Address - Fax:
Practice Address - Street 1:511 SE 5TH AVE APT 1901
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2978
Practice Address - Country:US
Practice Address - Phone:847-894-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCIERGE AESTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124453208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty