Healthcare Provider Details

I. General information

NPI: 1477749422
Provider Name (Legal Business Name): ELIZABETH BABCOCK, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 09/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SW 75TH ST SUITE 103
GAINESVILLE FL
32607-5779
US

IV. Provider business mailing address

100 SW 75TH ST SUITE 103
GAINESVILLE FL
32607-5779
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-2990
  • Fax: 352-332-7503
Mailing address:
  • Phone: 352-332-2990
  • Fax: 352-332-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME72504
License Number StateFL

VIII. Authorized Official

Name: DR. ELIZABETH ANN BABCOCK
Title or Position: OWNER
Credential: M.D.
Phone: 352-332-2990