Healthcare Provider Details

I. General information

NPI: 1083790265
Provider Name (Legal Business Name): DIGESTIVE DISEASE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W NEWBERRY ROAD SUITE 302
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6400 W NEWBERRY ROAD SUITE 308
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-8902
  • Fax: 352-332-7832
Mailing address:
  • Phone: 352-331-8902
  • Fax: 352-332-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0061492
License Number StateFL

VIII. Authorized Official

Name: DENNIS PATRICK COLLINS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 352-331-8902