Basic Information
| Provider Information | |||||||||
| NPI: | 1508846049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOC., LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1249 AMBLER AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256772626 | ||||||||
| FaxNumber: | 3256776835 | ||||||||
| Practice Location | |||||||||
| Address1: | 1249 AMBLER AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256772626 | ||||||||
| FaxNumber: | 3256776835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | ROARK | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3256772626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.