Provider Demographics
NPI:1871785204
Name:ADVANCED UROLOGY ASSOCIATES OF WEST PASCO PA
Entity type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES OF WEST PASCO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-372-7014
Mailing Address - Street 1:5305 GULF DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3960
Mailing Address - Country:US
Mailing Address - Phone:727-372-7014
Mailing Address - Fax:727-372-6661
Practice Address - Street 1:5305 GULF DR
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3960
Practice Address - Country:US
Practice Address - Phone:727-372-7014
Practice Address - Fax:727-372-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0060921208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH070Medicare PIN