Healthcare Provider Details

I. General information

NPI: 1639176498
Provider Name (Legal Business Name): STANLEY V DETURRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/10/2022
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 NumberME0082992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: