Provider Demographics
NPI:1164955027
Name:GULF COAST RHEUMATOLOGY, PLLC
Entity Type:Organization
Organization Name:GULF COAST RHEUMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:GRUNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACOI, FACR
Authorized Official - Phone:727-940-9391
Mailing Address - Street 1:850 E LIME ST # 1939
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4702
Mailing Address - Country:US
Mailing Address - Phone:727-940-9391
Mailing Address - Fax:727-937-4003
Practice Address - Street 1:9332 STATE ROAD 54 STE 301
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:727-940-9391
Practice Address - Fax:727-937-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9755207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty