Healthcare Provider Details

I. General information

NPI: 1568453892
Provider Name (Legal Business Name): SEASIDE RADIOLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 TAMIAMI TRAIL UNIT B
PORT CHARLOTTE FL
33952
US

IV. Provider business mailing address

3430 TAMIAMI TRAIL UNIT B
PORT CHARLOTTE FL
33952
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax: 941-206-3322
Mailing address:
  • Phone: 941-255-3535
  • Fax: 941-206-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES E. WHITE
Title or Position: OWNER - PRESIDENT
Credential: M.D.
Phone: 941-206-5200