Provider Demographics
NPI:1891768123
Name:GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-474-8988
Mailing Address - Street 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-476-5313
Practice Address - Street 1:5147 N 9TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8770
Practice Address - Country:US
Practice Address - Phone:850-477-2597
Practice Address - Fax:850-478-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254428802Medicaid
FL0176OtherHEALTH OPTIONS
AL529201330Medicaid
FL21821AOtherBCBS OF FLORIDA
CM1536OtherRAILROAD MEDICARE
CM1536OtherRAILROAD MEDICARE
FL21821AOtherBCBS OF FLORIDA
FL254428802Medicaid
=========002OtherTRICARE/CHAMPUS