Provider Demographics
NPI:1194011288
Name:GULF COAST PEDIATRICS, LLC
Entity Type:Organization
Organization Name:GULF COAST PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-445-4440
Mailing Address - Street 1:PO BOX 191178
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-6178
Mailing Address - Country:US
Mailing Address - Phone:251-445-4440
Mailing Address - Fax:251-445-4435
Practice Address - Street 1:5675 THREE NOTCH RD STE C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-1617
Practice Address - Country:US
Practice Address - Phone:251-445-4440
Practice Address - Fax:251-445-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty