Provider Demographics
NPI:1467497966
Name:SUNCOAST UROLOGY PA
Entity Type:Organization
Organization Name:SUNCOAST UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-862-8548
Mailing Address - Street 1:7614 JACQUE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7195
Mailing Address - Country:US
Mailing Address - Phone:727-862-8548
Mailing Address - Fax:727-863-4530
Practice Address - Street 1:7614 JACQUE RD
Practice Address - Street 2:SUITE A
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7195
Practice Address - Country:US
Practice Address - Phone:727-862-8548
Practice Address - Fax:727-863-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB2163OtherRR MEDICARE PROVIDER ID
FLCB2163OtherRR MEDICARE PROVIDER ID