Basic Information
| Provider Information | |||||||||
| NPI: | 1689742157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA CENTER OF GASTROENTEROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10115 W FOREST HILL BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617982425 | ||||||||
| FaxNumber: | 5617986356 | ||||||||
| Practice Location | |||||||||
| Address1: | 10115 W FOREST HILL BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617982425 | ||||||||
| FaxNumber: | 5617986356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617982425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | OS4502 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.