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General NPI Number Information
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NPI Number | 1962467373
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Entity Type | Organization
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Legal Business Name | GULF COAST KIDNEY ASSOCIATES, PL
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 1921 WALDEMERE ST SUITE 306
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City | SARASOTA
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State | FL
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Zip | 34239-2943
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Country | US
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Telephone | 941-917-8722
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Fax | 941-917-8727
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Provider Business Mailing Address
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Address Line | 1921 WALDEMERE ST SUITE 306
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City | SARASOTA
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State | FL
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Zip | 34239-2943
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Country | US
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Telephone | 941-917-8722
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Fax | 941-917-8727
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Authorized Official
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Title or Position | STAFF PHYSICIAN
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Name | DR. ANDREW L. LAZIN
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Credential | M.D.
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Telephone | 941-917-8722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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