Healthcare Provider Details

I. General information

NPI: 1356339840
Provider Name (Legal Business Name): SU-MIN OON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 NW 64TH TER SUITE C
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

777 HEMLOCK ST
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-5557
  • Fax: 352-331-5510
Mailing address:
  • Phone: 478-633-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberME76691
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME76691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: