Healthcare Provider Details

I. General information

NPI: 1194775783
Provider Name (Legal Business Name): DOCTORS RADIOLOGY GROUP OF GAINESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NW 11TH PL STE 200
GAINESVILLE FL
32605-4201
US

IV. Provider business mailing address

6716 NW 11TH PLACE STE 200
GAINESVILLE FL
32605-4215
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9729
  • Fax: 352-331-0136
Mailing address:
  • Phone: 352-331-9729
  • Fax: 352-331-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN E WARE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-331-9729