Healthcare Provider Details

I. General information

NPI: 1154481752
Provider Name (Legal Business Name): GULFCOAST PULMONARY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 ROWAN RD
NEW PORT RICHEY FL
34653-5601
US

IV. Provider business mailing address

4746 ROWAN RD
NEW PORT RICHEY FL
34653-5601
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-7788
  • Fax: 727-375-7727
Mailing address:
  • Phone: 727-375-7788
  • Fax: 727-375-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0075549 AKRAM
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0047363 NOORANI
License Number StateFL

VIII. Authorized Official

Name: MRS. DANEINE DURHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-375-7788