MEDICARE: BAY AREA GASTROINTESTINAL ENDOSCOPY AND LIVER SPECIALISTS LLC

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	174400000X	Specialist	ME64901	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699797266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA GASTROINTESTINAL ENDOSCOPY AND LIVER SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	SUITE E
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-631-0915
Fax Number	:	727-631-0916

Provider Business Practice Location Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	SUITE E
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-631-0915
Fax Number	:	727-631-0916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JODY S BERNER
Credential	:	MD
Telephone Number	:	727-631-0915

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/04/2008

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