MEDICARE: GASTROCARE, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	OS5402	FL

General Provider Information

NPI Number	:	1003909888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROCARE, LLP

Provider Business Mailing Address
First Line	:	10115 W FOREST HILL BLVD
Second Line	:	SUITE 100
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3105
Country	:	US
Telephone Number	:	561-798-2425
Fax Number	:	561-798-6356

Provider Business Practice Location Address
First Line	:	10115 W FOREST HILL BLVD
Second Line	:	SUITE 100
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3105
Country	:	US
Telephone Number	:	561-798-2425
Fax Number	:	561-798-6356

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW J SMITH
Credential	:	D.O.
Telephone Number	:	561-798-2425

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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1487760856 — DR. DAVID G. SIMON D.M.D.
Practice Location Address:

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Directions to “GASTROCARE, LLP ” Practice Location

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