Provider Demographics
NPI:1174655211
Name:DIGESTIVE DISEASE SPECIALIST OF MANATEE PL
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALIST OF MANATEE PL
Other - Org Name:DDSOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIMANTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALEPUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-761-1800
Mailing Address - Street 1:PO BOX 15089
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-5089
Mailing Address - Country:US
Mailing Address - Phone:941-761-1800
Mailing Address - Fax:941-761-1883
Practice Address - Street 1:4502 CORTEZ RD W STE 204
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3124
Practice Address - Country:US
Practice Address - Phone:941-761-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85682207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC1249OtherRAIL ROAD MEDICARE
FL6102336OtherCIGNA
FL271367500Medicaid
FL74735OtherBCBS
FL9751349OtherGHI
FL74735OtherBCBS