Provider Demographics
NPI:1881994606
Name:GULFSHORE PAIN & WELLNESS CENTRE
Entity type:Organization
Organization Name:GULFSHORE PAIN & WELLNESS CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ACTIVE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-874-1644
Mailing Address - Street 1:4700 N HABANA AVE
Mailing Address - Street 2:403
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE
Practice Address - Street 2:403
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7160
Practice Address - Country:US
Practice Address - Phone:813-874-1644
Practice Address - Fax:813-874-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain