Provider Demographics
NPI:1003880279
Name:ADVANCED GASTRO & LIVER CARE PA
Entity Type:Organization
Organization Name:ADVANCED GASTRO & LIVER CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJUNDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLAMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-521-0994
Mailing Address - Street 1:PO BOX 20267
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0267
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0823
Practice Address - Street 1:6225 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-521-0994
Practice Address - Fax:727-522-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68156207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34875OtherBCBS - GROUP #
34875OtherMCR - GROUP #
268039400OtherMCD
DA8281OtherMCR RR