Provider Demographics
NPI:1730213414
Name:THE GASTROENTEROLOGY GROUP
Entity type:Organization
Organization Name:THE GASTROENTEROLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SPRUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-261-0000
Mailing Address - Street 1:205 LORAINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-261-0000
Mailing Address - Fax:407-261-1000
Practice Address - Street 1:205 LORAINE DRIVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-261-0000
Practice Address - Fax:407-261-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
FL99577Medicare ID - Type Unspecified
=========OtherEIN