=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679507925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL FLORIDA GASTROENTEROLOGY P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 04/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1053 MEDICAL CENTER DR SUITE 251
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-8260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-775-4720
-----------------------------------------------------
Fax | 386-775-6343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1053 MEDICAL CENTER DR SUITE # 251
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-8260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-775-4720
-----------------------------------------------------
Fax | 386-775-6343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRUSTEE/SECRATERY
-----------------------------------------------------
Name | MRS. PURNA PARIKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-775-4720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME0060089
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------