Provider Demographics
NPI:1114019205
Name:GASTROENTEROLOGY CONSULTANTS OF THE
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF THE
Other - Org Name:GASTROENTEROLOGY CONSULTANTS OF THE PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-692-1373
Mailing Address - Street 1:1750 EL CAMINO REAL
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3228
Mailing Address - Country:US
Mailing Address - Phone:650-692-1373
Mailing Address - Fax:650-692-4209
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:SUITE 11
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3228
Practice Address - Country:US
Practice Address - Phone:650-692-1373
Practice Address - Fax:650-692-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty