Healthcare Provider Details

I. General information

NPI: 1295750933
Provider Name (Legal Business Name): ENRIQUE G. MOLINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W NEWBERRY RD SUITE 302
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6400 W NEWBERRY RD 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 NumberME0055874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: