Healthcare Provider Details

I. General information

NPI: 1457533614
Provider Name (Legal Business Name): FL GASTROENTEROLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 289
OCOEE FL
34761-3498
US

IV. Provider business mailing address

10000 W COLONIAL DR SUITE 289
OCOEE FL
34761-3498
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1911
  • Fax:
Mailing address:
  • Phone: 407-296-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANTONIO CAOS
Title or Position: PRESIDENT
Credential: MD
Phone: 407-296-1911