Healthcare Provider Details

I. General information

NPI: 1992586184
Provider Name (Legal Business Name): MARK ENFINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 NW 17TH RD
GAINESVILLE FL
32606-9272
US

IV. Provider business mailing address

9910 NW 17TH RD
GAINESVILLE FL
32606-9272
US

V. Phone/Fax

Practice location:
  • Phone: 352-519-0778
  • 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 Number123456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: