Healthcare Provider Details

I. General information

NPI: 1699059634
Provider Name (Legal Business Name): THOMAS M ZAVELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 NW 38TH ST
GAINESVILLE FL
32606-4534
US

IV. Provider business mailing address

4316 NW 38TH ST
GAINESVILLE FL
32606-4534
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-7137
  • Fax:
Mailing address:
  • Phone: 352-377-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17587
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: