Provider Demographics
NPI:1356531396
Name:COASTAL OB GYN AND INFERTILITY
Entity type:Organization
Organization Name:COASTAL OB GYN AND INFERTILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESSA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NOWITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-851-5000
Mailing Address - Street 1:7121 SPID
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412
Mailing Address - Country:US
Mailing Address - Phone:361-851-5000
Mailing Address - Fax:
Practice Address - Street 1:114A MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:361-851-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty