Basic Information
| Provider Information | |||||||||
| NPI: | 1982787255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COUNTY CENTER FOR DIGESTIVE HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 S OLD DIXIE HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 5617443083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 S OLD DIXIE HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 5617443083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOERNER | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617442200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.