Provider Demographics
NPI:1013168822
Name:GULFCOAST EAR NOSE & THROAT ASSOCIATES PA
Entity Type:Organization
Organization Name:GULFCOAST EAR NOSE & THROAT ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-942-4005
Mailing Address - Street 1:3007 RIDGELINE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9103
Mailing Address - Country:US
Mailing Address - Phone:727-942-4005
Mailing Address - Fax:727-934-1773
Practice Address - Street 1:3007 RIDGELINE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9103
Practice Address - Country:US
Practice Address - Phone:727-942-4005
Practice Address - Fax:727-934-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052177207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047382100Medicaid
FL047382100Medicaid