Healthcare Provider Details

I. General information

NPI: 1003895871
Provider Name (Legal Business Name): C. COUTS, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 U.S. HIGHWAY 27/441 SUITE C-2
FRUITLAND PARK FL
34731
US

IV. Provider business mailing address

3261 U.S. HIGHWAY 27/441 SUITE C-2
FRUITLAND PARK FL
34731
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-6050
  • Fax: 352-323-0913
Mailing address:
  • Phone: 352-323-6050
  • Fax: 352-323-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME92328
License Number StateFL

VIII. Authorized Official

Name: DR. CAROL A COUTS
Title or Position: ADULT PSYCHIATRIST
Credential: MD
Phone: 352-323-6050