Healthcare Provider Details

I. General information

NPI: 1033581996
Provider Name (Legal Business Name): FLORIDA MEDICAL & ALLERGY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 NW 13TH ST
GAINESVILLE FL
32601-4140
US

IV. Provider business mailing address

926 NW 13TH ST
GAINESVILLE FL
32601-4140
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-9355
  • Fax: 352-327-3649
Mailing address:
  • Phone: 352-505-9355
  • Fax: 352-327-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME88098
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88098
License Number StateFL

VIII. Authorized Official

Name: THOMAS J RAULERSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 352-505-9355