Basic Information
| Provider Information | |||||||||
| NPI: | 1386756997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY GASTROENTEROLOGY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 ENERGY CENTER BLVD BLDG 7 STE A | ||||||||
| Address2: | |||||||||
| City: | NORTHPORT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354735834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055230160 | ||||||||
| FaxNumber: | 2059860081 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 ENERGY CENTER BLVD BLDG 7 STE A | ||||||||
| Address2: | |||||||||
| City: | NORTHPORT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354735834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055230160 | ||||||||
| FaxNumber: | 2059860081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2055230160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 529923900 | 05 | AL | MEDICAID |