Healthcare Provider Details

I. General information

NPI: 1649546029
Provider Name (Legal Business Name): ALEKSEY ANDREYEVICH NOVIKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-2567
US

IV. Provider business mailing address

PO BOX 100214
GAINESVILLE FL
32610-0214
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9400
  • Fax: 352-265-7979
Mailing address:
  • Phone: 352-265-8982
  • Fax: 352-265-8979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD462844
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD462844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: