| Organization Name: | SUNCOAST VASCULAR CLINIC |
| NPI Number: | 1164598678 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARC J GOULET (CEO) |
| Mailing Address: | 3722 Central Ave Suite 6 Ft Myers |
| State: | FL US |
| Postal Code: | 339018247 |
| Phone Number: | 2392777700 |
| Fax Number: | 2392777070 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
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Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |