Organization
BAYSHORE PATHOLOGY CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA OQUENDO (CREDENTIALING SPECIALIST)
(941) 315-9955
Entity
Organization
Contact information
Practice address
18338 MURDOCK CIRCLE, PORT CHARLOTTE, FL 33948-1032
(941) 313-9009
(941) 623-9532
Mailing address
18338 MURDOCK CIRCLE, PORT CHARLOTTE, FL 33948-1032
(941) 313-9009
(941) 623-9532
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME70208
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005AY
FLORIDA BLUE
FL
05
—
110921700
—
FL
Enumeration date
12/06/2013
Last updated
03/06/2023
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