Provider Demographics
NPI:1710286067
Name:FIRST COAST OBSTETRICS AND GYNECOLOGY PA
Entity Type:Organization
Organization Name:FIRST COAST OBSTETRICS AND GYNECOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIEN - MAXIMIN
Authorized Official - Middle Name:YANOU
Authorized Official - Last Name:TCHUISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-325-5699
Mailing Address - Street 1:6100 SAINT JOHNS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6859
Mailing Address - Country:US
Mailing Address - Phone:386-325-5699
Mailing Address - Fax:386-325-5644
Practice Address - Street 1:6100 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-325-5699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207V00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-3815Medicare UPIN