Basic Information
| Provider Information | |||||||||
| NPI: | 1063980886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY GASTROENTEROLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4680 MCLEOD DR E | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897919133 | ||||||||
| FaxNumber: | 9897919135 | ||||||||
| Practice Location | |||||||||
| Address1: | 4680 MCLEOD DR E | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897919133 | ||||||||
| FaxNumber: | 9897919135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2018 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | LARKIN | ||||||||
| AuthorizedOfficialFirstName: | MEDLEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9897919133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.