Basic Information
| Provider Information | |||||||||
| NPI: | 1073985693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH POINT GASTROENTEROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 QUAKER LN | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 624 QUAKER LN | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | IZQUIERDO | ||||||||
| AuthorizedOfficialFirstName: | JOANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3368022105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 0010-04334 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.