Provider Demographics
NPI:1780923110
Name:ADVANCED SURGICAL EVOLUTIONS
Entity type:Organization
Organization Name:ADVANCED SURGICAL EVOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:III
Authorized Official - Credentials:CSFA
Authorized Official - Phone:727-204-7315
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34697-1142
Mailing Address - Country:US
Mailing Address - Phone:727-204-7315
Mailing Address - Fax:
Practice Address - Street 1:1141 PALM BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2237
Practice Address - Country:US
Practice Address - Phone:727-204-7315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129713246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty