Organization
GASTROENTEROLOGY SPECIALIST OF THE TREASURE COAST, INC
Active
Organization
GASTROENTEROLOGY SPECIALIST OF THE TREASURE COAST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYSHREE MATADIAL M.D. (PRESIDENT)
(772) 359-0091
Entity
Organization
Contact information
Practice address
501 NW LAKE WHITNEY PL STE 102, PORT ST LUCIE, FL 34986-1615
(772) 359-0091
Mailing address
PO BOX 8090, PORT ST LUCIE, FL 34985-8090
(772) 359-0091
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME77972
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME77972
MEDICAL LICENCE
FL
Enumeration date
10/08/2009
Last updated
05/26/2020
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