Healthcare Provider Details

I. General information

NPI: 1851448005
Provider Name (Legal Business Name): GULFCOAST PAIN PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD STE 210
SARASOTA FL
34233-5064
US

IV. Provider business mailing address

PO BOX 15947
SARASOTA FL
34277-1947
US

V. Phone/Fax

Practice location:
  • Phone: 941-256-3875
  • Fax:
Mailing address:
  • Phone: 941-256-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME78804
License Number StateFL

VIII. Authorized Official

Name: DR. ANGELO FONTE JR.
Title or Position: OWNER
Credential: MD
Phone: 941-256-3875