Healthcare Provider Details

I. General information

NPI: 1518044288
Provider Name (Legal Business Name): ST PETERSBURG EAR NOSE & THROAT CTR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 9TH AVE N SUITE 3B
ST PETERSBURG FL
33713-6800
US

IV. Provider business mailing address

2299 9TH AVE N SUITE 3B
ST PETERSBURG FL
33713-6800
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-3344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME90004
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME90004
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME90004
License Number StateFL

VIII. Authorized Official

Name: PATRICIA A GILROY
Title or Position: OWNER
Credential: M.D.
Phone: 727-321-3344