Healthcare Provider Details

I. General information

NPI: 1770787343
Provider Name (Legal Business Name): GARRETT ALAN HAUPTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 NW 11TH PLACE SUITE A
GAINESVILLE FL
32605
US

IV. Provider business mailing address

7135 NW 11TH PLACE
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-0090
  • Fax: 352-331-0094
Mailing address:
  • Phone: 352-331-0090
  • Fax: 352-331-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME100127
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberME100127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: