Basic Information
| Provider Information | |||||||||
| NPI: | 1407902539 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GASTROINTESTINAL ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3635 S CLYDE MORRIS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321292300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867881242 | ||||||||
| FaxNumber: | 3867884255 | ||||||||
| Practice Location | |||||||||
| Address1: | 3635 S CLYDE MORRIS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321292300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867881242 | ||||||||
| FaxNumber: | 3867884255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AGNONE | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | COORDINATING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3867881242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME56146 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.