Provider Demographics
NPI:1295726123
Name:GULF CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:GULF CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:UBILLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-3381
Mailing Address - Street 1:PO BOX 20205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0205
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:5326 GULF DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3920
Practice Address - Country:US
Practice Address - Phone:727-848-3381
Practice Address - Fax:727-848-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB0248OtherRAILROAD MEDICARE
FL372551100Medicaid
FLCB0248OtherRAILROAD MEDICARE