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NPI Code Detail

MEDICARE: MR. WAYNE D BOTTOM PA C

MEDICARE: MR. WAYNE D BOTTOM PA C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA1626FL

General Provider Information

NPI Number : 1952340861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAYNE D BOTTOM PA C
Provider Business Mailing Address
First Line : PO BOX 918025
Second Line :
City : ORLANDO
State : FL
Zip : 32891-8025
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-265-7955
Fax Number : 352-265-7996
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 01/11/2026

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Directions to “ MR. WAYNE D BOTTOM PA C” Practice Location

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