Provider Demographics
NPI:1023494762
Name:GULF COAST ACUPUNCTURE PHYSICIANS
Entity type:Organization
Organization Name:GULF COAST ACUPUNCTURE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:941-320-1719
Mailing Address - Street 1:3850 S OSPREY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6829
Mailing Address - Country:US
Mailing Address - Phone:941-320-1719
Mailing Address - Fax:
Practice Address - Street 1:3850 S OSPREY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6829
Practice Address - Country:US
Practice Address - Phone:941-320-1719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2534171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty