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General NPI Number Information
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NPI Number | 1083747380
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY SPECIALTIES, P.C.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 4545 R ST
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City | LINCOLN
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State | NE
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Zip | 68503-3799
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Country | US
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Telephone | 402-465-4545
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Fax | 402-465-3621
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Provider Business Mailing Address
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Address Line | 4545 R ST
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City | LINCOLN
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State | NE
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Zip | 68503-3799
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Country | US
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Telephone | 402-465-4545
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Fax | 402-465-3621
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | DR. MARK G GRIFFIN
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Credential | MD
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Telephone | 402-465-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 001-005685907
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License Number State | NE
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