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General NPI Number Information
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NPI Number | 1174527444
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Entity Type | Organization
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Legal Business Name | PENINSULA GASTROENTEROLOGY, PC
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 101 PHILIP ROTH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1393
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Country | US
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Telephone | 757-599-6333
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Fax | 757-599-9425
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Provider Business Mailing Address
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Address Line | 101 PHILIP ROTH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1393
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Country | US
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Telephone | 757-599-6333
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Fax | 757-599-9425
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST PERRY BUXTON III
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Credential | MD
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Telephone | 757-599-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | VA
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