Provider Demographics
NPI:1073600417
Name:FLORIDA UROLOGY SPECIALISTS
Entity Type:Organization
Organization Name:FLORIDA UROLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-309-7006
Mailing Address - Street 1:1 SOUTH SCHOOL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:941-309-7000
Mailing Address - Fax:941-309-7007
Practice Address - Street 1:1 SOUTH SCHOOL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-309-7000
Practice Address - Fax:941-309-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77832Medicare ID - Type Unspecified