Provider Demographics
NPI:1043506611
Name:CITRUS GASTROENTEROLOGY MGT PLC
Entity Type:Organization
Organization Name:CITRUS GASTROENTEROLOGY MGT PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHANNES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTENSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-344-8080
Mailing Address - Street 1:3653 E FOREST DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-0787
Mailing Address - Country:US
Mailing Address - Phone:352-344-8080
Mailing Address - Fax:352-344-0631
Practice Address - Street 1:3653 E FOREST DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-0787
Practice Address - Country:US
Practice Address - Phone:352-344-8080
Practice Address - Fax:352-344-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty