Healthcare Provider Details

I. General information

NPI: 1194797605
Provider Name (Legal Business Name): TARA M DYSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9400
  • Fax: 352-392-3618
Mailing address:
  • Phone: 352-273-9400
  • Fax: 352-392-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101238659
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME108675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: