Healthcare Provider Details

I. General information

NPI: 1003993254
Provider Name (Legal Business Name): NORTH FLORIDA REGIONAL OTOLARYNGOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W NEWBERRY RD SUITE 101 MAB
GAINESVILLE FL
32605-6605
US

IV. Provider business mailing address

6400 W NEWBERRY RD SUITE 101 MAB
GAINESVILLE FL
32605-6605
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5961
  • Fax:
Mailing address:
  • Phone: 352-333-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MARTIN
Title or Position: APM
Credential:
Phone: 352-333-5961