Healthcare Provider Details

I. General information

NPI: 1114088598
Provider Name (Legal Business Name): STUART FLANDERS TILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SW 13TH ST
GAINESVILLE FL
32608-1532
US

IV. Provider business mailing address

8028 SW 63RD LN
GAINESVILLE FL
32608-5583
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-371-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number51498105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: