Provider Demographics
NPI:1760118897
Name:SHOALS GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:SHOALS GASTROENTEROLOGY, LLC
Other - Org Name:OWENSBORO HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IONESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-991-7953
Mailing Address - Street 1:5311 TANNAT CT APT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5311 TANNAT CT APT 304
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4689
Practice Address - Country:US
Practice Address - Phone:917-991-7953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty