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General NPI Number Information
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NPI Number | 1992771422
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA CENTER OF GASTROENTEROLOGY
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 10115 FOREST HILL BLVD SUITE 100
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-798-2425
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Fax | 561-798-6356
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Provider Business Mailing Address
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Address Line | 10115 FOREST HILL BLVD SUITE 100
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-798-2425
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Fax | 561-798-6356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW J SMITH
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Credential | DO
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Telephone | 561-798-2425
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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 | 05-5402
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License Number State | FL
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