Basic Information
| Provider Information | |||||||||
| NPI: | 1316606023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 S DADELAND BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331562866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054684185 | ||||||||
| FaxNumber: | 8504765313 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 COBBLE CRK | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504772597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 02/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | FRENI | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3054587715 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA | ||||||||
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| NPICertificationDate: | 02/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.