Provider Demographics
NPI:1477730711
Name:FLORIDA GASTROENTEROLGOY SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:FLORIDA GASTROENTEROLGOY SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-405-6020
Mailing Address - Street 1:1713 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9631
Mailing Address - Country:US
Mailing Address - Phone:772-405-6020
Mailing Address - Fax:772-405-6025
Practice Address - Street 1:1713 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9631
Practice Address - Country:US
Practice Address - Phone:772-405-6020
Practice Address - Fax:772-405-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF-59015Medicare UPIN