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General NPI Number Information
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NPI Number | 1295923688
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Entity Type | Organization
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Legal Business Name | SUNCOAST OBSTETRICS AND GYNECOLOGY PA
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 582 SE 7TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4840
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Country | US
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Telephone | 352-564-8245
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1117
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423-1117
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Country | US
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Telephone | 352-564-8245
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Fax |
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | MRS. STACEY ANN LAWLOR
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Credential |
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Telephone | 352-564-8245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME62824
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License Number State | FL
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