Healthcare Provider Details

I. General information

NPI: 1831361690
Provider Name (Legal Business Name): SIVA SUBRAMANIAM IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD #100371
GAINESVILLE FL
32610-3001
US

IV. Provider business mailing address

PO BOX 100284
GAINESVILLE FL
32610-0284
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0301
  • Fax: 352-265-0627
Mailing address:
  • Phone: 352-273-8778
  • Fax: 352-273-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22805
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD205040
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME127344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: