Healthcare Provider Details

I. General information

NPI: 1396864708
Provider Name (Legal Business Name): GAINESVILLE ENDOCRINE & DIABETES ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD SUITE 204
GAINESVILLE FL
32605-4381
US

IV. Provider business mailing address

6440 W NEWBERRY RD SUITE 204
GAINESVILLE FL
32605-4381
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5440
  • Fax: 352-333-5272
Mailing address:
  • Phone: 352-333-5440
  • Fax: 352-333-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME70458
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN I. JONES III
Title or Position: DIRECTOR
Credential: M.D.
Phone: 352-333-5440