MEDICARE: GULF COAST NEPHROLOGY ASSOCIATES

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	207RN0300X	Nephrology Physician

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	:	1548230295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST NEPHROLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE D
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-848-1274
Fax Number	:	727-849-6409

Provider Business Practice Location Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE D
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-848-1274
Fax Number	:	727-849-6409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MING J WU
Credential	:	M.D.
Telephone Number	:	727-848-1274

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/22/2020

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Directions to “GULF COAST NEPHROLOGY ASSOCIATES ” Practice Location

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