Provider Demographics
NPI:1083668511
Name:FIRST COAST ALLERGY AND ASTHMA PA
Entity Type:Organization
Organization Name:FIRST COAST ALLERGY AND ASTHMA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-642-9001
Mailing Address - Street 1:9838 OLD BAYMEADOWS RD
Mailing Address - Street 2:PMB #358
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-642-9001
Mailing Address - Fax:904-642-9150
Practice Address - Street 1:9191 R.G. SKINNER PARKWAY
Practice Address - Street 2:SUITE 402
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-642-9001
Practice Address - Fax:904-642-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87944207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID
FLH67469Medicare UPIN
FL=========OtherFEDERAL TAX ID