MEDICARE: WESTCHASE GASTROENTEROLOGY P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME66502	OTHER	FL	STATE LIC NUMBER

General Provider Information

NPI Number	:	1356540785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCHASE GASTROENTEROLOGY P A

Provider Business Mailing Address
First Line	:	11912 SHELDON RD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3643
Country	:	US
Telephone Number	:	813-920-8882
Fax Number	:	813-920-8883

Provider Business Practice Location Address
First Line	:	11912 SHELDON RD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3643
Country	:	US
Telephone Number	:	813-920-8882
Fax Number	:	813-920-8883

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN CHANG
Credential	:	M.D.
Telephone Number	:	813-920-8882

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	12/06/2007

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Directions to “WESTCHASE GASTROENTEROLOGY P A ” Practice Location

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