Healthcare Provider Details

I. General information

NPI: 1114098100
Provider Name (Legal Business Name): COMPREHENSIVE PATHOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 13TH ST
HOMESTEAD FL
33030-4228
US

IV. Provider business mailing address

PO BOX 552010
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-1960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME35809
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME35809
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME35809
License Number StateFL

VIII. Authorized Official

Name: EDWIN GOULD
Title or Position: DIRECTOR
Credential: MD
Phone: 305-596-1960