Provider Demographics
NPI:1225019649
Name:J PAONESSA MD PA
Entity Type:Organization
Organization Name:J PAONESSA MD PA
Other - Org Name:GULFCOAST ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARULYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRYSTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-821-0017
Mailing Address - Street 1:1201 5TH AVENUE NORTH
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705
Mailing Address - Country:US
Mailing Address - Phone:727-821-0017
Mailing Address - Fax:727-502-8861
Practice Address - Street 1:1201 5TH AVENUE NORTH
Practice Address - Street 2:SUITE 505
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:727-821-0017
Practice Address - Fax:727-895-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376230100Medicaid
FL33119Medicare PIN
FL376230100Medicaid
FL33119Medicare UPIN
FL1168350001Medicare NSC