Provider Demographics
NPI:1215914072
Name:COASTAL INTERNAL MEDICINE SPECIALISTS, PA
Entity type:Organization
Organization Name:COASTAL INTERNAL MEDICINE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-936-7171
Mailing Address - Street 1:5172 MASON CORBIN COURT
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7533
Mailing Address - Country:US
Mailing Address - Phone:239-936-7171
Mailing Address - Fax:239-936-7455
Practice Address - Street 1:5172 MASON CORBIN COURT
Practice Address - Street 2:STE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7533
Practice Address - Country:US
Practice Address - Phone:239-936-7171
Practice Address - Fax:239-936-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty