Healthcare Provider Details

I. General information

NPI: 1548935216
Provider Name (Legal Business Name): MICHAEL JOSEPH LAVERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER FL 4
GAINESVILLE FL
32606-9277
US

IV. Provider business mailing address

4037 NW 86TH TER FL 4
GAINESVILLE FL
32606-9277
US

V. Phone/Fax

Practice location:
  • Phone: 352-594-1500
  • Fax:
Mailing address:
  • Phone: 352-594-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number65654
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME160236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: