Provider Demographics
NPI:1639734155
Name:GULF COAST MEDICAL CARE VHD
Entity Type:Organization
Organization Name:GULF COAST MEDICAL CARE VHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDDASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-393-5265
Mailing Address - Street 1:PO BOX 15722
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0123
Mailing Address - Country:US
Mailing Address - Phone:237-393-5265
Mailing Address - Fax:
Practice Address - Street 1:5485 FIRETHORN PT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-9512
Practice Address - Country:US
Practice Address - Phone:267-393-5265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty