Surfside Family Practice LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME00059920 Issued in FL

Legal business name

SURFSIDE FAMILY PRACTICE LLC

Practice address

3000 N Atlantic Ave
Suite 108
Cocoa Beach, FL 32931-5078

Phone

(321) 799-2554

Fax

(321) 799-4750

NPI assigned

Oct 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Harry Allen Earle, M.D.

Title

Doctor

Phone

(321) 799-2554

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1780872705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE",
            "address_2": "SUITE 108",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315078",
            "telephone_number": "321-799-2554",
            "fax_number": "321-799-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE",
            "address_2": "SUITE 108",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315078",
            "telephone_number": "321-799-2554",
            "fax_number": "321-799-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "EARLE",
        "authorized_official_first_name": "HARRY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "321-799-2554",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME00059920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055552599",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AG997",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellwood Herbert Stoddard, RPH
• Lori Jean Stottler, LMHC
• Sunshine Healthcare Solutions Inc
• Sunshine Healthcare Solutions of Brevard LLC (Sunshine Healthcare Solutions)
• Surfside Family Medicine LLC
• Surgical Specialists of Central Brevard PA
• Joseph C Sutly
• Amy Swan, AGNP-C
• Synergistic Resonance LLC (Dr. Marsha Chiropractic)
• Brandon Taival, DO

• Primary Care Clinic/Center in Cocoa Beach, FL
• Providers in Cocoa Beach, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.