Provider Demographics
NPI:1215111299
Name:ASHBY, COEURLIDA LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:COEURLIDA
Middle Name:LOUIS
Last Name:ASHBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COEURLIDA
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-272-6240
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:3402 N 22ND ST
Practice Address - Street 2:TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1214
Practice Address - Country:US
Practice Address - Phone:813-272-6240
Practice Address - Fax:813-866-0929
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001260700Medicaid
FLCB869ZMedicare PIN