Basic Information
Provider Information
NPI: 1548274194
EntityType: 2
ReplacementNPI:  
OrganizationName: OB/GYN ASSOCIATES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 6450 38TH AVE N
Address2: #200
City: SAINT PETERSBURG
State: FL
PostalCode: 337101645
CountryCode: US
TelephoneNumber: 7273446060
FaxNumber: 7273475586
Practice Location
Address1: 6450 38TH AVE N
Address2: #200
City: SAINT PETERSBURG
State: FL
PostalCode: 337101645
CountryCode: US
TelephoneNumber: 7273446060
FaxNumber: 7273475586
Other Information
ProviderEnumerationDate: 07/28/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CARLSON
AuthorizedOfficialFirstName: JEFFREY
AuthorizedOfficialMiddleName: K
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7273446060
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0000X FLY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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