Basic Information
| Provider Information | |||||||||
| NPI: | 1427709146 | ||||||||
| 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 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331562866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054684185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 204 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325614392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364563 | ||||||||
| FaxNumber: | 8504364570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2022 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | FRENI | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3054587715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.