Healthcare Provider Details

I. General information

NPI: 1396737615
Provider Name (Legal Business Name): SURGICAL GROUP OF GAINESVILLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

1143 NW 64TH TER
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-1201
  • Fax: 352-331-5273
Mailing address:
  • Phone: 352-331-1201
  • Fax: 352-331-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0060950
License Number StateFL

VIII. Authorized Official

Name: DR. PANAGIOTIS SARANTOS
Title or Position: PRESIDENT
Credential: MD
Phone: 352-331-1201