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General NPI Number Information
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NPI Number | 1851542500
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY SERVICES, LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 2572 SR 426 WEST SUITE 1000
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City | OVIEDO
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State | FL
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Zip | 32765
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Country | US
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Telephone | 407-478-0882
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Fax | 407-359-8530
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Provider Business Mailing Address
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Address Line | 2572 SR 426 WEST SUITE 1000
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City | OVIEDO
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State | FL
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Zip | 32765
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Country | US
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Telephone | 407-478-0882
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Fax | 407-359-8530
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | IAN R MARTINEZ
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Credential | MD
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Telephone | 407-244-2506
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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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