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General NPI Number Information
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NPI Number | 1689112989
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Entity Type | Organization
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Legal Business Name | FLORIDA GASTRO PARTNERS LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE SUITE 211
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-498-4000
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Fax | 561-498-4005
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Provider Business Mailing Address
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Address Line | 1325 S CONGRESS AVE SUITE 211
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-498-4000
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Fax | 561-498-4005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK R DOSCH
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Credential | MD
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Telephone | 561-498-4000
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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 | 48457
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License Number State | FL
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