Healthcare Provider Details

I. General information

NPI: 1558338319
Provider Name (Legal Business Name): GULF COAST MEDICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 BEE RIDGE RD SUITE 210
SARASOTA FL
34233-5088
US

IV. Provider business mailing address

5831 BEE RIDGE RD SUITE 210
SARASOTA FL
34233-5088
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-8481
  • Fax: 941-379-3781
Mailing address:
  • Phone: 941-379-8481
  • Fax: 941-379-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MARC LOUNDY
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 941-379-8481