Provider Demographics
NPI:1023126463
Name:GULFCOAST OB GYN PA
Entity type:Organization
Organization Name:GULFCOAST OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:727-344-4651
Mailing Address - Street 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8602
Mailing Address - Country:US
Mailing Address - Phone:727-344-4651
Mailing Address - Fax:727-347-6224
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:SUITE 200A
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8602
Practice Address - Country:US
Practice Address - Phone:727-344-4651
Practice Address - Fax:727-347-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99582Medicare ID - Type Unspecified