Basic Information
| Provider Information | |||||||||
| NPI: | 1427163682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA GASTROENTEROLOGY ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37908 DAUGHTERY ROAD | ||||||||
| Address2: | STE A | ||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335411316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137808620 | ||||||||
| FaxNumber: | 8137808619 | ||||||||
| Practice Location | |||||||||
| Address1: | 37908 DAUGHTERY ROAD | ||||||||
| Address2: | STE A | ||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335411316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137808620 | ||||||||
| FaxNumber: | 8137808619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | MAY | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | CAROL | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8137808620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME0064410 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | H6445 | 01 | FL | RAILROAD MEDICARE | OTHER |