Provider Demographics
NPI:1831210889
Name:GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA P.L.
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:NAGINLAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-737-2300
Mailing Address - Street 1:4123 UNIVERSITY BLVD S STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4320
Mailing Address - Country:US
Mailing Address - Phone:904-737-2300
Mailing Address - Fax:904-737-2441
Practice Address - Street 1:4123 UNIVERSITY BLVD S STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4320
Practice Address - Country:US
Practice Address - Phone:904-737-2300
Practice Address - Fax:904-737-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38507207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066207100Medicaid
FLK9425Medicare ID - Type UnspecifiedGI ASSOCIATES OF NE FL
FL066207100Medicaid