MEDICARE: FLORIDA DIGESTIVE SPECIALISTS, PA

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	174400000X	Specialist	ME36704	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922102078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DIGESTIVE SPECIALISTS, PA

Provider Business Mailing Address
First Line	:	5651 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2105
Country	:	US
Telephone Number	:	727-443-4299
Fax Number	:	727-443-0255

Provider Business Practice Location Address
First Line	:	5651 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2105
Country	:	US
Telephone Number	:	727-443-4299
Fax Number	:	727-443-0255

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. IVELISS VIERA
Credential	:
Telephone Number	:	727-443-4299

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	09/17/2020

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