Healthcare Provider Details

I. General information

NPI: 1750922399
Provider Name (Legal Business Name): GASTROENTEROLOGY CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E REDSTONE AVE STE B
CRESTVIEW FL
32539-5343
US

IV. Provider business mailing address

PO BOX 30119
PENSACOLA FL
32503-1119
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-8605
  • Fax: 850-398-8470
Mailing address:
  • Phone: 850-398-8605
  • Fax: 850-398-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KHALID MOUSSA
Title or Position: DR
Credential: MD
Phone: 225-405-5441