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General NPI Number Information
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NPI Number | 1861703811
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Entity Type | Organization
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Legal Business Name | FLORIDA GASTROENTEROLOGY CLINIC LLC
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 3599 UNIVERSITY BLVD S SAMUEL WELLS COMPLEX SUITE 8
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 917-664-9972
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Fax |
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Provider Business Mailing Address
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Address Line | 7917 ABINGTON HILLS LN
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3428
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Country | US
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Telephone | 904-619-5225
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. GEORGE HAGE-NASSAR
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Credential | MD
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Telephone | 904-619-5225
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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 | ME105540
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License Number State | FL
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