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General NPI Number Information
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NPI Number | 1134299753
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Entity Type | Organization
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Legal Business Name | ASSOCIATED COASTAL EAR NOSE & THROAT PHYSICIANS PA
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 4632 S. 25TH STREET
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City | FORT PIERCE
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State | FL
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Zip | 34981
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Country | US
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Telephone | 954-587-4218
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Fax | 954-587-4219
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Provider Business Mailing Address
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Address Line | 4632 S 25TH STREET
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City | FORT PIERCE
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State | FL
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Zip | 34981
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Country | US
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Telephone | 772-464-9595
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Fax | 772-464-9582
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MICHELLE BROWNING
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Credential |
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Telephone | 772-464-9595
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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 |
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License Number State |
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