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General NPI Number Information
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NPI Number | 1497482160
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Entity Type | Organization
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Legal Business Name | MIAMI GASTRO AT THE KEYS, P.A.
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 103400 OVERSEAS HWY STE 251
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City | KEY LARGO
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State | FL
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Zip | 33037-2831
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Country | US
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Telephone | 786-589-5298
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Fax | 509-420-9737
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Provider Business Mailing Address
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Address Line | PO BOX 801240
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City | MIAMI
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State | FL
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Zip | 33280-1240
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Country | US
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Telephone | 786-589-5298
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Fax | 209-420-9737
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Authorized Official
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Title or Position | OWNER
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Name | DANNY JUAN AVALOS
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Credential | MD
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Telephone | 786-589-5298
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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 |
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