Healthcare Provider Details

I. General information

NPI: 1902820772
Provider Name (Legal Business Name): CATHERINE MARY BLACKBAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 NW 48THTERRACE SUITE 101
GAINESVILLE FL
32606-7229
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5230
  • Fax: 352-265-5230
Mailing address:
  • Phone: 352-338-2195
  • Fax: 352-338-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME90058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: