Organization
UNIVERSITY PEDIATRIC GASTROENTEROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD P RABALAIS MD (CHAIRMAN)
(502) 852-8600
Entity
Organization
Contact information
Practice address
720 2ND ST, STE 102, BOWLING GREEN, KY 42101-1778
(502) 852-7670
(502) 852-7743
Mailing address
PO BOX 2469, LOUISVILLE, KY 40201-2469
(502) 852-8500
(502) 852-8556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200945670
—
IN
05
—
7100063520
—
KY
Enumeration date
03/17/2011
Last updated
04/05/2011
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