Healthcare Provider Details

I. General information

NPI: 1962898163
Provider Name (Legal Business Name): JAIRO MARTIN OLIVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1715
US

IV. Provider business mailing address

PO BOX 100383
GAINESVILLE FL
32610-0383
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-1161
  • Fax:
Mailing address:
  • Phone: 352-392-4541
  • Fax: 352-294-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME138665
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME138665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: