Healthcare Provider Details

I. General information

NPI: 1750355830
Provider Name (Legal Business Name): PULMONARY PHYSICIANS OF GAINESVILLE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 NW 8TH AVENUE SUITE C
GAINESVILLE FL
32605
US

IV. Provider business mailing address

4741 NW 8TH AVE STE C
GAINESVILLE FL
32605-5511
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-0302
  • Fax: 352-371-0456
Mailing address:
  • Phone: 352-375-0302
  • Fax: 352-371-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0043168
License Number StateFL

VIII. Authorized Official

Name: JOSEPH ARTHUR TONNER
Title or Position: OWNER PARTNER OFFICER
Credential: MD
Phone: 352-375-0302