Organization
CENTER FOR DIGESTIVE DISEASES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY F JACKSON (SCHEDULE COORNIDATOR)
(727) 384-2016
Entity
Organization
Contact information
Practice address
1609 PASADENA AVE S, STE 3M, ST PETERSBURG, FL 33707-4563
(727) 384-2016
(727) 343-3791
Mailing address
PO BOX 20267, TAMPA, FL 33622-0267
(727) 823-2188
(727) 828-0723
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME48637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24038
BCBS
FL
05
—
373745400
—
FL
01
—
CL1357
RAILROAD MEDICARE
FL
Enumeration date
07/08/2006
Last updated
06/18/2009
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