Healthcare Provider Details

I. General information

NPI: 1417904210
Provider Name (Legal Business Name): CYNTHIA JANE GRIES M.D., MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA JANE DE RUITER MD

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

PO BOX 100225
GAINESVILLE FL
32610-0225
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-273-8737
  • Fax: 352-273-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD438817
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD438817
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD438817
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: