Healthcare Provider Details

I. General information

NPI: 1396786364
Provider Name (Legal Business Name): JOHN GRAHAM POLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOHN GRAHAM-POLE

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-1532
  • Fax: 352-392-8725
Mailing address:
  • Phone: 352-265-0301
  • Fax: 352-265-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME40068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: