Provider Demographics
NPI:1083603625
Name:GASTROENTEROLOGY CONSULTANTS OF CENTRAL FLORIDA PA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF CENTRAL FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-277-8665
Mailing Address - Street 1:10800 DYLAN LOREN CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4437
Mailing Address - Country:US
Mailing Address - Phone:407-277-8665
Mailing Address - Fax:407-277-1267
Practice Address - Street 1:10800 DYLAN LOREN CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4437
Practice Address - Country:US
Practice Address - Phone:407-277-8665
Practice Address - Fax:407-277-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003313200Medicaid
FL40814Medicare ID - Type Unspecified
FL40814Medicare PIN