Healthcare Provider Details

I. General information

NPI: 1508869405
Provider Name (Legal Business Name): GAINESVILLE RADIOLOGY GROUP WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 W NEWBERRY RD STE 280
GAINESVILLE FL
32607-2201
US

IV. Provider business mailing address

4960 W NEWBERRY RD STE 280
GAINESVILLE FL
32607-2201
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-3336
  • Fax: 352-371-3372
Mailing address:
  • Phone: 352-371-3336
  • Fax: 352-371-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number256176
License Number StateFL

VIII. Authorized Official

Name: TONY ARVESU
Title or Position: MANAGING MEMBER
Credential:
Phone: 352-332-2040