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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