Provider Demographics
NPI:1518989318
Name:GULF COAST EMERGENCY PHYSICIANS PA
Entity Type:Organization
Organization Name:GULF COAST EMERGENCY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-629-1181
Mailing Address - Street 1:PO BOX 12370
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2370
Mailing Address - Country:US
Mailing Address - Phone:866-488-4558
Mailing Address - Fax:405-607-1326
Practice Address - Street 1:21298 OLEAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33949
Practice Address - Country:US
Practice Address - Phone:941-629-1181
Practice Address - Fax:405-607-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77789OtherBCBS
=========OtherTRICARE
FL77789Medicare ID - Type Unspecified