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General NPI Number Information
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NPI Number | 1629250428
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES OF THE TREASURE COAST, P.A.
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1700 SE HILLMOOR DR SUITE 402
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-335-7883
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Fax | 772-335-3143
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Provider Business Mailing Address
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Address Line | 1700 SE HILLMOOR DR SUITE 402
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-335-7883
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Fax | 772-335-3143
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH RALPH KOHEN
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Credential | M.D.
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Telephone | 772-335-7883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37070
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License Number State | FL
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