Healthcare Provider Details

I. General information

NPI: 1568222743
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF PENSACOLA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 SW 87TH AVE STE 200
MIAMI FL
33176-2416
US

IV. Provider business mailing address

9408 SW 87TH AVE STE 200
MIAMI FL
33176-2416
US

V. Phone/Fax

Practice location:
  • Phone: 305-913-0666
  • Fax: 305-913-0663
Mailing address:
  • Phone: 305-913-0666
  • Fax: 305-913-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820