Healthcare Provider Details

I. General information

NPI: 1417937525
Provider Name (Legal Business Name): EMERALD COAST GASTROENTEROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417A RACETRACK RD NW SUITE 2
FT WALTON BEACH FL
32547-4612
US

IV. Provider business mailing address

417A RACETRACK RD NW SUITE 2
FT WALTON BEACH FL
32547-4612
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-5990
  • Fax: 850-862-0041
Mailing address:
  • Phone: 850-863-5990
  • Fax: 850-862-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0068568
License Number StateFL

VIII. Authorized Official

Name: ANDREW FRANKLIN RINGEL
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 850-863-5990