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General NPI Number Information
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NPI Number | 1871554634
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES OF ST AUGUSTINE, PA
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 216 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5135
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Country | US
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Telephone | 904-824-6108
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Fax | 904-823-9613
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Provider Business Mailing Address
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Address Line | 216 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5135
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Country | US
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Telephone | 904-824-6108
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Fax | 904-823-9613
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANTIAGO A ROSADO
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Credential | M.D.
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Telephone | 904-824-6108
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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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