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General NPI Number Information
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NPI Number | 1982642922
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Entity Type | Organization
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Legal Business Name | GASTRO-INTESTINAL CONSULTANTS OF CENTRAL FLORIDA, LLC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2060 N DONNELLY ST
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City | MOUNT DORA
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State | FL
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Zip | 32757-2824
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Country | US
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Telephone | 352-383-7703
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Fax | 352-383-8875
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Provider Business Mailing Address
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Address Line | PO BOX 1077
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City | MOUNT DORA
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State | FL
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Zip | 32756-1077
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Country | US
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Telephone | 352-383-7703
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Fax | 352-383-8875
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Authorized Official
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Title or Position | MANAGER
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Name | LALBAHADUR S NAGABHAIRU
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Credential | MD
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Telephone | 352-383-7703
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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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