Basic Information
| Provider Information | |||||||||
| NPI: | 1215353289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BGST GI, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 S CONGRESS AVE | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334265876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617322900 | ||||||||
| FaxNumber: | 5617349240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CONGRESS AVE | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334265876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617322900 | ||||||||
| FaxNumber: | 5617349240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2014 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | BROMER | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | Q | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5617322900 | ||||||||
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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 | OS059155 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.