Healthcare Provider Details

I. General information

NPI: 1164474235
Provider Name (Legal Business Name): GAINESVILLE HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3900
  • Fax: 352-332-5009
Mailing address:
  • Phone: 352-332-3900
  • Fax: 352-332-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCY MEDLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-332-3900