Provider Demographics
NPI:1679589428
Name:GULF COAST PHYSICIAN PARTNERS
Entity Type:Organization
Organization Name:GULF COAST PHYSICIAN PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, GULF COAST PHYSICIAN PAR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-623-9787
Mailing Address - Street 1:5992 BERRYHILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1013
Mailing Address - Country:US
Mailing Address - Phone:850-623-9787
Mailing Address - Fax:
Practice Address - Street 1:5992 BERRYHILL RD STE 300
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1014
Practice Address - Country:US
Practice Address - Phone:850-623-9787
Practice Address - Fax:850-626-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3718531Medicaid
FL3718531Medicaid
FL3718531Medicaid