Healthcare Provider Details

I. General information

NPI: 1801320122
Provider Name (Legal Business Name): NICHOLAS DOHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8500
US

IV. Provider business mailing address

PO BOX 100236
GAINESVILLE FL
32610-0236
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5550
  • Fax:
Mailing address:
  • Phone: 352-273-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS17826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: