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General NPI Number Information
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NPI Number | 1215353289
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Entity Type | Organization
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Legal Business Name | BGST GI, LLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE SUITE 211
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-732-2900
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Fax | 561-734-9240
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Provider Business Mailing Address
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Address Line | 1325 S CONGRESS AVE SUITE 211
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-732-2900
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Fax | 561-734-9240
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW Q BROMER
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Credential | D.O.
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Telephone | 561-732-2900
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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 | OS059155
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License Number State | FL
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