Basic Information
| Provider Information | |||||||||
| NPI: | 1659557767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GULFCOAST ANESTHESIA ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2323 CURLEW RD | ||||||||
| Address2: | BLDG 5 | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346989330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277718333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2323 CURLEW RD | ||||||||
| Address2: | BLDG 5 | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346989330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277718333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | LACAMERA | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7277718333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 26177915 | 01 | FL | TAX ID | OTHER |