=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477605939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY ASSOC. OF SARASOTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 01/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2089 HAWTHORNE ST SUITE 200
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-365-6556
-----------------------------------------------------
Fax | 941-365-6678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2089 HAWTHORNE ST SUITE 200
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-365-6556
-----------------------------------------------------
Fax | 941-365-6678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | DEBRA DAVIDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-556-1415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------