Organization
PEDIATRIC GASTROENTEROLOGY OF FLORIDA , PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYSHREE GANATRA M.D. (PRESIDENT)
(239) 561-6365
Entity
Organization
Contact information
Practice address
13770 PLANTATION RD, UNIT 4, FORT MYERS, FL 33912-4460
(239) 561-6365
(239) 561-6264
Mailing address
13770 PLANTATION RD, UNIT 4, FORT MYERS, FL 33912
(239) 561-6365
(239) 561-6264
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
ME82537
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262706600
—
FL
Enumeration date
01/12/2009
Last updated
03/29/2018
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