Healthcare Provider Details

I. General information

NPI: 1083603625
Provider Name (Legal Business Name): GASTROENTEROLOGY CONSULTANTS OF CENTRAL FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DYLAN LOREN CIR SUITE 102
ORLANDO FL
32825-4437
US

IV. Provider business mailing address

10800 DYLAN LOREN CIR SUITE 102
ORLANDO FL
32825-4437
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-8665
  • Fax: 407-277-1267
Mailing address:
  • Phone: 407-277-8665
  • Fax: 407-277-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEITH R MOORE
Title or Position: PHYSICIAN
Credential: DO
Phone: 407-277-8665