Healthcare Provider Details

I. General information

NPI: 1831419068
Provider Name (Legal Business Name): ERIN LESSNER BLACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 NW 9TH BLVD STE 2
GAINESVILLE FL
32605-4263
US

IV. Provider business mailing address

5408 SW 93RD TER
GAINESVILLE FL
32608-4327
US

V. Phone/Fax

Practice location:
  • Phone: 352-514-5829
  • Fax: 864-522-3975
Mailing address:
  • Phone: 352-514-5829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberME119178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: