Organization
COMMONWEALTH GASTROENTEROLOGY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN KELLER STADIG MBA, CMPE (ADMINISTRATOR)
(859) 967-2055
Entity
Organization
Contact information
Practice address
177 BURT RD, BURT ROAD MEDICAL CLINIC, LEXINGTON, KY 40503-2410
(859) 967-2055
(859) 278-8488
Mailing address
177 BURT RD, BURT ROAD MEDICAL CLINIC, LEXINGTON, KY 40503-2410
(859) 967-2055
(859) 278-8488
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65930695
—
KY
Enumeration date
11/15/2006
Last updated
05/05/2008
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