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General NPI Number Information
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NPI Number | 1710169248
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Entity Type | Organization
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Legal Business Name | BAY AREA NEPHROLOGY, PL
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 1305 S FORT HARRISON AVE BUILDING H
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City | CLEARWATER
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State | FL
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Zip | 33756-3301
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Country | US
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Telephone | 727-441-0104
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Fax | 727-441-8272
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Provider Business Mailing Address
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Address Line | 1305 S FORT HARRISON AVE BUILDING H
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City | CLEARWATER
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State | FL
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Zip | 33756-3301
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Country | US
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Telephone | 727-441-0104
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Fax | 727-441-8272
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD THOMAS NEEDHAM JR.
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Credential | D.O.
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Telephone | 727-441-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | OS7262
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License Number State | FL
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