Provider Demographics
NPI:1295277911
Name:FLORIDA UROLOGY SPECIALISTS LLC
Entity type:Organization
Organization Name:FLORIDA UROLOGY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-309-7000
Mailing Address - Street 1:1 S SCHOOL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6014
Mailing Address - Country:US
Mailing Address - Phone:941-309-7000
Mailing Address - Fax:941-309-7009
Practice Address - Street 1:1 S SCHOOL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6014
Practice Address - Country:US
Practice Address - Phone:941-309-7000
Practice Address - Fax:941-309-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00454542088P0231X
FLME0059349208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty