Healthcare Provider Details

I. General information

NPI: 1326580648
Provider Name (Legal Business Name): ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32117-5535
US

IV. Provider business mailing address

1893 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32117-5535
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-0531
  • Fax:
Mailing address:
  • Phone: 386-677-0531
  • Fax:

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. MARK ALLEN RINER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 386-677-0531