Provider Demographics
NPI:1194928200
Name:GULF COAST UROLOGY LLC
Entity type:Organization
Organization Name:GULF COAST UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-943-8761
Mailing Address - Street 1:102 S GREENTREE LANE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4509
Mailing Address - Country:US
Mailing Address - Phone:251-943-8761
Mailing Address - Fax:251-947-8761
Practice Address - Street 1:102 S GREENTREE LANE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-4509
Practice Address - Country:US
Practice Address - Phone:251-943-8761
Practice Address - Fax:251-947-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO879208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty