Provider Demographics
NPI:1154481752
Name:GULFCOAST PULMONARY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GULFCOAST PULMONARY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-375-7788
Mailing Address - Street 1:4746 ROWAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-5601
Mailing Address - Country:US
Mailing Address - Phone:727-375-7788
Mailing Address - Fax:727-375-7727
Practice Address - Street 1:4746 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5601
Practice Address - Country:US
Practice Address - Phone:727-375-7788
Practice Address - Fax:727-375-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047363 NOORANI207RP1001X
FLME0075549 AKRAM207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259355600Medicaid
K1917Medicare ID - Type Unspecified