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General NPI Number Information
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NPI Number | 1528068624
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Entity Type | Organization
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Legal Business Name | FIRST COAST GASTROENTEROLOGY
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 100 WHETSTONE PL SUITE 105
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5773
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Country | US
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Telephone | 904-829-9557
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Fax | 904-829-9125
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Provider Business Mailing Address
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Address Line | 100 WHETSTONE PL SUITE 105
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5773
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Country | US
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Telephone | 904-829-9557
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Fax | 904-829-9125
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. BENOIT C PINEAU
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Credential | MD
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Telephone | 904-829-9557
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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 | ME90376
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License Number State | FL
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