Healthcare Provider Details

I. General information

NPI: 1316223894
Provider Name (Legal Business Name): GASTROINTESTINAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 QUINCY ST
BROCKTON MA
02302-2967
US

IV. Provider business mailing address

189 QUINCY ST
BROCKTON MA
02302-2967
US

V. Phone/Fax

Practice location:
  • Phone: 508-588-6700
  • Fax: 508-584-3010
Mailing address:
  • Phone: 508-588-6700
  • Fax: 508-584-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JERRY S STERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-588-6700