Provider Demographics
NPI:1114927951
Name:GULF COAST OBSTETRICS & GYNECOLOGY LTD
Entity Type:Organization
Organization Name:GULF COAST OBSTETRICS & GYNECOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS OFC MGR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WYPISZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-379-6331
Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:941-379-6331
Mailing Address - Fax:941-379-5642
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 390
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:941-379-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21161Medicare PIN