Basic Information
| Provider Information | |||||||||
| NPI: | 1417177940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLIN S BEACH MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY CARE AT TAMPA PALMS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15285 AMBERLY DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139796978 | ||||||||
| FaxNumber: | 8139750534 | ||||||||
| Practice Location | |||||||||
| Address1: | 15285 AMBERLY DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139796978 | ||||||||
| FaxNumber: | 8139750534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEACH | ||||||||
| AuthorizedOfficialFirstName: | COLIN | ||||||||
| AuthorizedOfficialMiddleName: | SANDY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8139796978 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.