Provider Demographics
NPI:1215353289
Name:BGST GI, LLC
Entity type:Organization
Organization Name:BGST GI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BROMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-732-2900
Mailing Address - Street 1:1325 S CONGRESS AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5876
Mailing Address - Country:US
Mailing Address - Phone:561-732-2900
Mailing Address - Fax:561-734-9240
Practice Address - Street 1:1325 S CONGRESS AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5876
Practice Address - Country:US
Practice Address - Phone:561-732-2900
Practice Address - Fax:561-734-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS059155207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty