Healthcare Provider Details

I. General information

NPI: 1629099213
Provider Name (Legal Business Name): JOHN CHRISTOPHER OELTJEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100138
GAINESVILLE FL
32610-0138
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-8402
  • Fax: 352-627-4173
Mailing address:
  • Phone: 352-265-8402
  • Fax: 352-627-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME96192
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME96192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: