Healthcare Provider Details

I. General information

NPI: 1528045002
Provider Name (Legal Business Name): DIGESTIVE DISEASE CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAITLAND AVE STE 2200
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

623 MAITLAND AVE STE 2200
ALTAMONTE SPRINGS FL
32701
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-8661
  • Fax: 407-830-0280
Mailing address:
  • Phone: 407-830-8661
  • Fax: 407-830-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTY A MCINTYRE
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 407-830-8661