Healthcare Provider Details

I. General information

NPI: 1629098751
Provider Name (Legal Business Name): PETER S. JIANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-7406
US

IV. Provider business mailing address

PO BOX 100254
GAINESVILLE FL
32610-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-559-5051
  • Fax:
Mailing address:
  • Phone: 352-273-8610
  • Fax: 352-273-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME80455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: