Provider Demographics
NPI:1699059808
Name:PEZZONE GASTROENTEROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:PEZZONE GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:PEZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-674-8700
Mailing Address - Street 1:1400 N US HIGHWAY 441 STE 810
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8987
Mailing Address - Country:US
Mailing Address - Phone:352-674-8700
Mailing Address - Fax:352-674-8714
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 810
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8987
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060508L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001812538Medicaid
PA042001D8RMedicare PIN
PA001812538Medicaid