Healthcare Provider Details

I. General information

NPI: 1104622398
Provider Name (Legal Business Name): JOHN WALTER KALAF JR. PMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SE DEPOT AVE
GAINESVILLE FL
32601-7085
US

IV. Provider business mailing address

606 SE DEPOT AVE
GAINESVILLE FL
32601-7085
US

V. Phone/Fax

Practice location:
  • Phone: 352-215-3304
  • Fax:
Mailing address:
  • Phone: 352-215-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number525590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: