Basic Information
| Provider Information | |||||||||
| NPI: | 1225019649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J PAONESSA MD PA | ||||||||
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| OtherOrganizationName: | GULFCOAST ONCOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 5TH AVENUE NORTH | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278210017 | ||||||||
| FaxNumber: | 7275028861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 5TH AVENUE NORTH | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278210017 | ||||||||
| FaxNumber: | 7278950328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | FRYSTAK | ||||||||
| AuthorizedOfficialFirstName: | MARULYN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7278210017 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 376230100 | 05 | FL | MEDICAID |