Provider Demographics
NPI:1821289042
Name:GULFSHORE SURGICAL ASSOCIATES PL
Entity Type:Organization
Organization Name:GULFSHORE SURGICAL ASSOCIATES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-774-4275
Mailing Address - Street 1:8340 COLLIER BLVD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114
Mailing Address - Country:US
Mailing Address - Phone:239-774-4275
Mailing Address - Fax:239-774-4792
Practice Address - Street 1:8340 COLLIER BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114
Practice Address - Country:US
Practice Address - Phone:239-774-4275
Practice Address - Fax:239-774-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80817208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35818OtherBLUE CROSS BLUE SHIELD
FL259382300Medicaid
FL259382300Medicaid