Provider Demographics
NPI:1528122827
Name:GASTROENTEROLOGY CONSULTANTS OF CLEARWATER
Entity type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF CLEARWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-443-7700
Mailing Address - Street 1:508 JEFFORDS ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3839
Mailing Address - Country:US
Mailing Address - Phone:727-443-7700
Mailing Address - Fax:727-443-7701
Practice Address - Street 1:508 JEFFORDS STREET STE D
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-443-7700
Practice Address - Fax:727-443-7701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CENTRAL GASTROENTEROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250263100Medicaid
FL40893Medicare ID - Type UnspecifiedGROUP