Healthcare Provider Details

I. General information

NPI: 1912534884
Provider Name (Legal Business Name): WELL BALANCED HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD STE 409
GAINESVILLE FL
32605-4370
US

IV. Provider business mailing address

6440 W NEWBERRY RD STE 409
GAINESVILLE FL
32605-4370
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-6161
  • Fax: 352-333-6162
Mailing address:
  • Phone: 352-333-6161
  • Fax: 352-333-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J BAILEY
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 352-333-6161