Healthcare Provider Details

I. General information

NPI: 1992941868
Provider Name (Legal Business Name): ADVANCE GASTROENTEROLOGY AND PULMONARY CARE PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7128 SAGHEER ST
BROOKSVILLE FL
34613-6535
US

IV. Provider business mailing address

7128 SAGHEER ST
BROOKSVILLE FL
34613-6535
US

V. Phone/Fax

Practice location:
  • Phone: 352-345-4876
  • Fax: 352-345-4880
Mailing address:
  • Phone: 352-345-4876
  • Fax: 352-345-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME70282
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME70282
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME103045
License Number StateFL

VIII. Authorized Official

Name: SYED BIN-SAGHEER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 352-345-4876