Basic Information
| Provider Information | |||||||||
| NPI: | 1235223785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4828 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504778109 | ||||||||
| FaxNumber: | 8504765313 | ||||||||
| Practice Location | |||||||||
| Address1: | 4531 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364563 | ||||||||
| FaxNumber: | 8504364570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8504748988 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 254428800 | 05 | FL | MEDICAID | 529503660 | 05 | AL | MEDICAID | 0084 | 01 | HEALTH OPTIONS | OTHER | 21821B | 01 | FL | BCBS OF FL | OTHER | CA7936 | 01 | RAILROAD MEDICARE | OTHER |