Healthcare Provider Details

I. General information

NPI: 1467460444
Provider Name (Legal Business Name): GAINESVILLE GYNECOLOGY GROUP, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 NW 11TH PLACE
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6730 NW 11TH PLACE
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3234
  • Fax: 352-332-7095
Mailing address:
  • Phone: 352-331-3234
  • Fax: 352-332-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLI C ROSS
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 352-331-3234