Healthcare Provider Details

I. General information

NPI: 1881214815
Provider Name (Legal Business Name): JUSTIN P HARRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 10/18/2024
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD
GAINESVILLE FL
32607-2817
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-8202
  • Fax: 352-375-6888
Mailing address:
  • Phone: 352-416-1082
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME169164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME169164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: