Provider Demographics
NPI:1619160678
Name:OCEAN MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:OCEAN MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-785-8000
Mailing Address - Street 1:1850 SW FOUNTAINVIEW BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3443
Mailing Address - Country:US
Mailing Address - Phone:772-785-8000
Mailing Address - Fax:772-785-8150
Practice Address - Street 1:1800 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7521
Practice Address - Country:US
Practice Address - Phone:772-785-8000
Practice Address - Fax:772-785-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9452208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16226XMedicare PIN