Provider Demographics
NPI:1417937525
Name:EMERALD COAST GASTROENTEROLOGY, PA
Entity type:Organization
Organization Name:EMERALD COAST GASTROENTEROLOGY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:RINGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-863-5990
Mailing Address - Street 1:417A RACETRACK RD NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4612
Mailing Address - Country:US
Mailing Address - Phone:850-863-5990
Mailing Address - Fax:850-862-0041
Practice Address - Street 1:417A RACETRACK RD NW
Practice Address - Street 2:SUITE 2
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4612
Practice Address - Country:US
Practice Address - Phone:850-863-5990
Practice Address - Fax:850-862-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068568207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377977700Medicaid
FLDS7915OtherRRB MEDICARE - GROUP
G07504Medicare UPIN
FLFX590AMedicare Oscar/Certification