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General NPI Number Information
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NPI Number | 1750922399
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY CARE SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 150 E REDSTONE AVE STE B
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City | CRESTVIEW
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State | FL
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Zip | 32539-5343
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Country | US
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Telephone | 850-398-8605
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Fax | 850-398-8470
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Provider Business Mailing Address
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Address Line | 150 E REDSTONE AVE STE B
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City | CRESTVIEW
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State | FL
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Zip | 32539-5343
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Country | US
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Telephone | 850-398-8605
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Fax | 850-398-8470
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Authorized Official
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Title or Position | DR
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Name | DR. KHALID MOUSSA
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Credential | MD
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Telephone | 225-405-5441
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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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