Provider Demographics
NPI:1447694971
Name:ENDOCRINOLOGY CONSULTANTS OF ST. PETERSBURG
Entity type:Organization
Organization Name:ENDOCRINOLOGY CONSULTANTS OF ST. PETERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GOVINDAN
Authorized Official - Middle Name:POTTETH
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-321-6768
Mailing Address - Street 1:4820 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7218
Mailing Address - Country:US
Mailing Address - Phone:727-321-6768
Mailing Address - Fax:727-327-8741
Practice Address - Street 1:4820 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7218
Practice Address - Country:US
Practice Address - Phone:727-321-6768
Practice Address - Fax:727-327-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty