Healthcare Provider Details

I. General information

NPI: 1316996945
Provider Name (Legal Business Name): GASTROENTEROLOGY AND NUTRITION OF CENTRAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 PERKINS ST
LEESBURG FL
34748-4350
US

IV. Provider business mailing address

822 PERKINS ST
LEESBURG FL
34748-4350
US

V. Phone/Fax

Practice location:
  • Phone: 352-315-4111
  • Fax: 352-315-4112
Mailing address:
  • Phone: 352-315-4111
  • Fax: 352-315-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEHME GABRIEL
Title or Position: OWNER
Credential: MD
Phone: 352-638-3883