1942399613 NPI number — DEAN J GOBO MD PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942399613 NPI number — DEAN J GOBO MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAN J GOBO MD PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942399613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 MORTON PLANT ST
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756-3398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-298-6121
Provider Business Mailing Address Fax Number:
727-298-6151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 MORTON PLANT ST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756-3398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-298-6121
Provider Business Practice Location Address Fax Number:
727-298-6151
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLBASSANI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
727-298-6121

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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