Healthcare Provider Details

I. General information

NPI: 1194010694
Provider Name (Legal Business Name): LAURIE ANN SOLOMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEWELL DR # L4100
GAINESVILLE FL
32611-1912
US

IV. Provider business mailing address

100 NEWELL DR # L4100
GAINESVILLE FL
32611-1912
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-3681
  • Fax:
Mailing address:
  • Phone: 352-392-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME119398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME119398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: