Healthcare Provider Details

I. General information

NPI: 1154635928
Provider Name (Legal Business Name): ALI ATAYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD PULMONARY DEPARTMENT
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD PULMONARY DEPARTMENT
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME126206
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME126206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: