Provider Demographics
NPI:1962431031
Name:GULF COAST SPINE & ORTHOPAEDIC INSTITUTE PLLC
Entity type:Organization
Organization Name:GULF COAST SPINE & ORTHOPAEDIC INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANZANARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-514-2642
Mailing Address - Street 1:PO BOX 110788
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0114
Mailing Address - Country:US
Mailing Address - Phone:239-514-2642
Mailing Address - Fax:239-514-2643
Practice Address - Street 1:8340 COLLIER BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3625
Practice Address - Country:US
Practice Address - Phone:239-514-2642
Practice Address - Fax:239-514-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82473207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261490100Medicaid