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General NPI Number Information
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NPI Number | 1013168822
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Entity Type | Organization
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Legal Business Name | GULFCOAST EAR NOSE & THROAT ASSOCIATES PA
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 3007 RIDGELINE BLVD SUITE A
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-9103
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Country | US
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Telephone | 727-942-4005
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Fax | 727-934-1773
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Provider Business Mailing Address
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Address Line | 3007 RIDGELINE BLVD SUITE A
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-9103
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Country | US
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Telephone | 727-942-4005
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Fax | 727-934-1773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE ALBERTO BERRIOS
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Credential | M.D.
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Telephone | 727-942-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME0052177
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License Number State | FL
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