Healthcare Provider Details

I. General information

NPI: 1659355014
Provider Name (Legal Business Name): GASTRO CONSULTANTS, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN ST SUITE F
HOLLYWOOD FL
33021-3420
US

IV. Provider business mailing address

4700 SHERIDAN ST SUITE M
HOLLYWOOD FL
33021-3420
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8400
  • Fax: 954-961-8401
Mailing address:
  • Phone: 954-961-8400
  • Fax: 954-961-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MITCHELL R. RAPS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 954-961-8400