Healthcare Provider Details

I. General information

NPI: 1215013081
Provider Name (Legal Business Name): GAINESVILLE OUTPATIENT ANESTHESIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 NEWBERRY ROAD
GAINESVILLE FL
32607-2247
US

IV. Provider business mailing address

4131 NW 13TH STREET SUITE 101
GAINESVILLE FL
32609-1858
US

V. Phone/Fax

Practice location:
  • Phone: 352-367-2310
  • Fax: 352-367-2512
Mailing address:
  • Phone: 352-376-1887
  • Fax: 352-375-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: KATHERINE B WALSH
Title or Position: PRESIDENT
Credential: MD
Phone: 352-367-2310