Provider Demographics
NPI:1417177940
Name:COLIN S BEACH MD PA
Entity Type:Organization
Organization Name:COLIN S BEACH MD PA
Other - Org Name:FAMILY CARE AT TAMPA PALMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:SANDY
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-979-6978
Mailing Address - Street 1:15285 AMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2155
Mailing Address - Country:US
Mailing Address - Phone:813-979-6978
Mailing Address - Fax:813-975-0534
Practice Address - Street 1:15285 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2155
Practice Address - Country:US
Practice Address - Phone:813-979-6978
Practice Address - Fax:813-975-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty