=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154481752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULFCOAST PULMONARY ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4746 ROWAN RD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-375-7788
-----------------------------------------------------
Fax | 727-375-7727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4746 ROWAN RD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-375-7788
-----------------------------------------------------
Fax | 727-375-7727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. DANEINE DURHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-375-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME0075549 AKRAM
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME0047363 NOORANI
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------