Healthcare Provider Details

I. General information

NPI: 1770567497
Provider Name (Legal Business Name): CEDARS GASTROENTEROLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST SUITE 402
MIAMI FL
33125-1673
US

IV. Provider business mailing address

1321 NW 14TH ST SUITE 402
MIAMI FL
33125-1673
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-4410
  • Fax: 305-325-4405
Mailing address:
  • Phone: 305-325-4410
  • Fax: 305-325-4405

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. GARY DUNCAN
Title or Position: VP
Credential:
Phone: 561-548-1089