Healthcare Provider Details

I. General information

NPI: 1093847360
Provider Name (Legal Business Name): JEREMY MICHAEL ARCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0703
US

IV. Provider business mailing address

PO BOX 100297
GAINESVILLE FL
32610-0297
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5422
  • Fax:
Mailing address:
  • Phone: 406-238-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME109914
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMED-PHYS-LIC-21131
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME109914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: