Provider Demographics
NPI:1508846049
Name:GASTROENTEROLOGY ASSOC., LLP
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOC., LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-677-2626
Mailing Address - Street 1:1249 AMBLER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2351
Mailing Address - Country:US
Mailing Address - Phone:325-677-2626
Mailing Address - Fax:325-677-6835
Practice Address - Street 1:1249 AMBLER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2351
Practice Address - Country:US
Practice Address - Phone:325-677-2626
Practice Address - Fax:325-677-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty