Healthcare Provider Details

I. General information

NPI: 1376561449
Provider Name (Legal Business Name): JAMES GERSHOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 NW 11TH PL
GAINESVILLE FL
32605-4216
US

IV. Provider business mailing address

6821 NW 11TH PL
GAINESVILLE FL
32605-4216
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-6700
  • Fax:
Mailing address:
  • Phone: 352-331-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME38170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: