Provider Demographics
NPI:1508954470
Name:SOUTHCOAST ALLERGY PA
Entity Type:Organization
Organization Name:SOUTHCOAST ALLERGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-279-6520
Mailing Address - Street 1:1723 WREN WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7103
Mailing Address - Country:US
Mailing Address - Phone:850-279-6520
Mailing Address - Fax:850-897-1259
Practice Address - Street 1:4400 E HIGHWAY 20
Practice Address - Street 2:SUITE 501
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8779
Practice Address - Country:US
Practice Address - Phone:850-279-6520
Practice Address - Fax:850-897-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78816207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME78816OtherDR.S MEDICAL LICENSE
FLME78816OtherDR.S MEDICAL LICENSE