Healthcare Provider Details

I. General information

NPI: 1720143852
Provider Name (Legal Business Name): SEGUNDO JOEL CARDENAS- GOICOECHEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD BOX 100294
GAINESVILLE FL
32610
US

IV. Provider business mailing address

1600 SW ARCHER ROAD BOX 100294
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7584
  • Fax: 352-392-3498
Mailing address:
  • Phone: 352-273-7584
  • Fax: 352-392-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-120960
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT187907
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME126605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: