Healthcare Provider Details

I. General information

NPI: 1003042854
Provider Name (Legal Business Name): GULSUN ERDAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GULSUN EROGLU MD

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0010
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100275
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9900
  • Fax: 352-265-9901
Mailing address:
  • Phone: 352-265-9900
  • Fax: 352-265-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME136909
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME136909
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD72968
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME136909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: