Healthcare Provider Details

I. General information

NPI: 1801959077
Provider Name (Legal Business Name): PALM HARBOR PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 SR 584 SUITE W
PALM HARBOR FL
34684
US

IV. Provider business mailing address

2595 SR 584 SUITE W
PALM HARBOR FL
34684
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-3092
  • Fax: 727-786-1714
Mailing address:
  • Phone: 727-785-3092
  • Fax: 727-786-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSA ENID GAUD
Title or Position: PRESIDENT
Credential: MD
Phone: 727-785-3092