Healthcare Provider Details

I. General information

NPI: 1801239496
Provider Name (Legal Business Name): FLORIDA DIGESTIVE SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5767 49TH ST N
ST PETERSBURG FL
33709-2107
US

IV. Provider business mailing address

5767 49TH ST N
ST PETERSBURG FL
33709-2107
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-0558
  • Fax: 727-521-3605
Mailing address:
  • Phone: 727-522-0558
  • Fax: 727-521-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JAYAPRAKASH K KAMATH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-522-0558