Provider Demographics
NPI:1548711344
Name:DIGESTIVE & LIVER DISEASE CONSULTANTS OF SOUTH FLORIDA PA
Entity type:Organization
Organization Name:DIGESTIVE & LIVER DISEASE CONSULTANTS OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-451-5932
Mailing Address - Street 1:7369 SHERIDAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2776
Mailing Address - Country:US
Mailing Address - Phone:954-451-5932
Mailing Address - Fax:954-949-4351
Practice Address - Street 1:7369 SHERIDAN ST STE 300
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2776
Practice Address - Country:US
Practice Address - Phone:954-451-5932
Practice Address - Fax:954-949-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0800X
FLME118726207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Multi-Specialty