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General NPI Number Information
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NPI Number | 1174655211
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASE SPECIALIST OF MANATEE PL
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 4502 CORTEZ RD W STE 204
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City | BRADENTON
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State | FL
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Zip | 34210-3124
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Country | US
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Telephone | 941-761-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15089
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City | BRADENTON
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State | FL
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Zip | 34280-5089
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Country | US
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Telephone | 941-761-1800
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Fax | 941-761-1883
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RIMANTAS ZALEPUGA
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Credential | M.D.
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Telephone | 941-761-1800
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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 | ME85682
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License Number State | FL
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