Healthcare Provider Details

I. General information

NPI: 1750709713
Provider Name (Legal Business Name): JAMES MEDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # 100237
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

1600 SW ARCHER RD # 100237
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5159
  • Fax: 352-273-5213
Mailing address:
  • Phone: 352-273-5159
  • Fax: 352-273-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME131952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: