MEDICARE: GULFCOAST EAR NOSE & THROAT ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	ME0052177	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013168822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFCOAST EAR NOSE & THROAT ASSOCIATES PA

Provider Business Mailing Address
First Line	:	3007 RIDGELINE BLVD
Second Line	:	SUITE A
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9103
Country	:	US
Telephone Number	:	727-942-4005
Fax Number	:	727-934-1773

Provider Business Practice Location Address
First Line	:	3007 RIDGELINE BLVD
Second Line	:	SUITE A
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9103
Country	:	US
Telephone Number	:	727-942-4005
Fax Number	:	727-934-1773

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE ALBERTO BERRIOS
Credential	:	M.D.
Telephone Number	:	727-942-4005

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/16/2008

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Directions to “GULFCOAST EAR NOSE & THROAT ASSOCIATES PA ” Practice Location

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