Healthcare Provider Details

I. General information

NPI: 1568549178
Provider Name (Legal Business Name): RAKESH SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD
GAINESVILLE FL
32607-2817
US

IV. Provider business mailing address

4881 NW 8TH AVE STE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-224-2204
  • Fax: 352-375-6888
Mailing address:
  • Phone: 352-224-2204
  • Fax: 352-224-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35074089
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 105202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: