Provider Demographics
NPI:1548464480
Name:BAY AREA OB GYN, PA
Entity type:Organization
Organization Name:BAY AREA OB GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:ULYSESS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-975-9788
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD
Mailing Address - Street 2:201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
Mailing Address - Country:US
Mailing Address - Phone:813-975-9788
Mailing Address - Fax:813-971-9716
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD
Practice Address - Street 2:201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-975-9788
Practice Address - Fax:813-971-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50388Medicare UPIN
FL02189Medicare ID - Type Unspecified