Provider Demographics
NPI:1700846060
Name:DURHAM GASTROENTEROLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:DURHAM GASTROENTEROLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:BRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-806-8322
Mailing Address - Street 1:249 E NC HIGHWAY 54
Mailing Address - Street 2:STE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-806-8322
Mailing Address - Fax:919-433-0409
Practice Address - Street 1:249 E NC HIGHWAY 54
Practice Address - Street 2:STE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-806-8322
Practice Address - Fax:919-433-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015YTMedicaid
2328425Medicare PIN