Basic Information
| Provider Information | |||||||||
| NPI: | 1124159082 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DALY KLIBANOFF PEEBLES & ZEITLIN MD PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GULFCOAST GASTROENTEROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33920 US HIGHWAY 19 N | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346842654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277857654 | ||||||||
| FaxNumber: | 7277870061 | ||||||||
| Practice Location | |||||||||
| Address1: | 33920 US HIGHWAY 19 N | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346842654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277857654 | ||||||||
| FaxNumber: | 7277870061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7277857654 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.