Healthcare Provider Details

I. General information

NPI: 1245276484
Provider Name (Legal Business Name): AZRA BIHORAC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ACHER 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: 352-265-0463
  • Fax: 352-338-9812
Mailing address:
  • Phone: 352-265-0463
  • Fax: 352-338-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME91859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: