Basic Information
| Provider Information | |||||||||
| NPI: | 1720628662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY CONSULTANTS OF BOCA RATON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 NW 13TH ST STE 2E | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614553145 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 NW 13TH ST STE 2E | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614553145 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2020 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | SALOMON | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5614553145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/08/2020 | ||||||||
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.