Healthcare Provider Details

I. General information

NPI: 1871895425
Provider Name (Legal Business Name): DOWNTOWN CENTER FOR ORIENTAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SW 4TH AVE SUITE 2
GAINESVILLE FL
32601-1805
US

IV. Provider business mailing address

211 SW 4TH AVE SUITE 2
GAINESVILLE FL
32601-1805
US

V. Phone/Fax

Practice location:
  • Phone: 352-226-4433
  • Fax:
Mailing address:
  • Phone: 352-226-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2916, AP 2902
License Number StateFL

VIII. Authorized Official

Name: JAMES LEE BROOKS
Title or Position: MANAGING MEMBER
Credential: LCSW-R, AP
Phone: 352-226-4433