Healthcare Provider Details

I. General information

NPI: 1659567303
Provider Name (Legal Business Name): GAINESVILLE PLASTIC SURGERY ASSOCIATES PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 NW 9TH BLVD SUITE 2
GAINESVILLE FL
32605-4269
US

IV. Provider business mailing address

6801 NW 9TH BLVD SUITE 2
GAINESVILLE FL
32605-4269
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3401
  • Fax: 352-332-0922
Mailing address:
  • Phone: 352-331-3401
  • Fax: 352-332-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CONNIE GRUENWALD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 352-331-3401