=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346286259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLASTIC SURGERY ASSOCIATES OF S. FL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2006
-----------------------------------------------------
Last Update Date | 05/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6610 WILLOW PARK DR SUITE 104
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-566-8000
-----------------------------------------------------
Fax | 239-596-4015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6610 WILLOW PARK DR SUITE 104
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-596-8000
-----------------------------------------------------
Fax | 239-596-4015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STANLEY P GULIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-596-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------