Healthcare Provider Details

I. General information

NPI: 1760448765
Provider Name (Legal Business Name): ALEXANDER JAEWOOK RIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 64TH TERRACE STE A
GAINESVILLE FL
32605
US

IV. Provider business mailing address

1121 NW 64TH TERRACE STE A
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-6777
  • Fax: 352-331-8899
Mailing address:
  • Phone: 352-331-6777
  • Fax: 352-331-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME91673
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME91673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: