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General NPI Number Information
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NPI Number | 1346286226
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Entity Type | Organization
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Legal Business Name | WEST COAST PATHOLOGY OF FLORIDA PA
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 11375 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5409
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Country | US
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Telephone | 305-665-4614
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Fax | 770-776-5966
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Provider Business Mailing Address
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Address Line | PO BOX 60100
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City | CHARLESTON
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State | SC
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Zip | 29419-0100
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Country | US
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Telephone | 305-665-4614
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Fax | 770-776-5966
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHLEEN MOBLEY
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Credential | MD
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Telephone | 352-596-6632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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