Provider Demographics
NPI:1275534059
Name:GULF COAST ANESTHESIA LLC
Entity Type:Organization
Organization Name:GULF COAST ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ELZAWAHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-0400
Mailing Address - Street 1:767 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4000
Mailing Address - Country:US
Mailing Address - Phone:850-747-0400
Mailing Address - Fax:850-913-9744
Practice Address - Street 1:767 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4000
Practice Address - Country:US
Practice Address - Phone:850-747-0400
Practice Address - Fax:850-913-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL04000049725207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74982OtherBCBS
FLK6279Medicare ID - Type Unspecified