Healthcare Provider Details

I. General information

NPI: 1013191105
Provider Name (Legal Business Name): ILIE TOMA BARB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

IV. Provider business mailing address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-2500
  • Fax: 352-416-0135
Mailing address:
  • Phone: 352-264-2500
  • Fax: 352-416-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number002032
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 112264
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME 112264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: