1154481752 NPI number — GULFCOAST PULMONARY ASSOCIATES, P.A.

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 1154481752 NPI number — GULFCOAST PULMONARY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULFCOAST PULMONARY ASSOCIATES, P.A.
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:
1154481752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4746 ROWAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34653-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-375-7788
Provider Business Mailing Address Fax Number:
727-375-7727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4746 ROWAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34653-5601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-375-7788
Provider Business Practice Location Address Fax Number:
727-375-7727
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DURHAM
Authorized Official First Name:
DANEINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
727-375-7788

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME0075549 AKRAM , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: ME0047363 NOORANI , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 259355600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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