MEDICARE: SUNCOAST GASTROENTEROLOGY PA

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

General Provider Information

NPI Number	:	1972820298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST GASTROENTEROLOGY PA

Provider Business Mailing Address
First Line	:	PO BOX 606
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34423-0606
Country	:	US
Telephone Number	:	352-634-0255
Fax Number	:	352-419-6310

Provider Business Practice Location Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	352-726-9006
Fax Number	:	352-726-4527

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FERNANDO BUENO
Credential	:	M.D.
Telephone Number	:	352-634-0255

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	11/22/2014

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