MEDICARE: SOUTH FLORIDA CENTER OF GASTROENTEROLOGY

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	05-5402	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	:	1992771422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA CENTER OF GASTROENTEROLOGY

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

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

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	03/07/2023

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