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General NPI Number Information
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NPI Number | 1821022161
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 2222 53RD AVENUE
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City | BETTENDORF
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State | IA
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Zip | 52753
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Country | US
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Telephone | 563-383-2686
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Fax | 563-884-8144
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Provider Business Mailing Address
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Address Line | 2222 53RD AVENUE
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City | BETTENDORF
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State | IA
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Zip | 52753
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Country | US
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Telephone | 563-383-2686
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Fax | 563-884-8144
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ERLING LARSON III
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Credential | M.D.
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Telephone | 563-383-2686
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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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