Healthcare Provider Details

I. General information

NPI: 1215121983
Provider Name (Legal Business Name): GAINESVILLE ENT AND ALLERGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 NW 11TH PL SUITE A
GAINESVILLE FL
32605
US

IV. Provider business mailing address

7135 NW 11TH PL SUITE A
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-0090
  • Fax: 352-331-0094
Mailing address:
  • Phone: 352-331-0090
  • Fax: 352-331-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME84079
License Number StateFL

VIII. Authorized Official

Name: DR. JEREMY SETH MELKER
Title or Position: OWNER
Credential: M.D.
Phone: 352-331-0090