Healthcare Provider Details

I. General information

NPI: 1003295767
Provider Name (Legal Business Name): BAY AREA GASTROENTEROLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SHORT BRANCH DR SUITE 102
TRINITY FL
34655-4425
US

IV. Provider business mailing address

PO BOX 1149
ODESSA FL
33556-1050
US

V. Phone/Fax

Practice location:
  • Phone: 813-230-2884
  • Fax:
Mailing address:
  • Phone: 813-230-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME110297
License Number StateFL

VIII. Authorized Official

Name: JIGNESHKUMAR B PATEL
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 813-230-2884