Provider Demographics
NPI:1548230295
Name:GULF COAST NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:GULF COAST NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MING
Authorized Official - Middle Name:J
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-1274
Mailing Address - Street 1:4738 GRAND BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5170
Mailing Address - Country:US
Mailing Address - Phone:727-848-1274
Mailing Address - Fax:727-849-6409
Practice Address - Street 1:4738 GRAND BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5170
Practice Address - Country:US
Practice Address - Phone:727-848-1274
Practice Address - Fax:727-849-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21340Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER