Healthcare Provider Details

I. General information

NPI: 1477987675
Provider Name (Legal Business Name): HENRY ST. GEORGE TEAFORD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1500
US

IV. Provider business mailing address

PO BOX 100234
GAINESVILLE FL
32610-0234
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4357
  • Fax: 352-627-4160
Mailing address:
  • Phone: 352-265-4357
  • Fax: 352-627-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME145372
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME145372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: