Healthcare Provider Details

I. General information

NPI: 1578530457
Provider Name (Legal Business Name): KHALED FOUAD ELRAIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8163
US

IV. Provider business mailing address

1329 SW 16TH ST STE 5251
GAINESVILLE FL
32608-1128
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9400
  • Fax:
Mailing address:
  • Phone: 352-273-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC1-0011172
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME148173
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20577
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: