Provider Demographics
NPI:1255403689
Name:FIRST COAST PULMONARY ASSOCIATES
Entity type:Organization
Organization Name:FIRST COAST PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BORBELYQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-819-6800
Mailing Address - Street 1:150 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5179
Mailing Address - Country:US
Mailing Address - Phone:904-819-6800
Mailing Address - Fax:904-819-6700
Practice Address - Street 1:3 PINE CONE DR
Practice Address - Street 2:SUITE # 106
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8685
Practice Address - Country:US
Practice Address - Phone:386-986-1422
Practice Address - Fax:386-986-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2911Medicare ID - Type UnspecifiedGROUP NUMBER