Healthcare Provider Details

I. General information

NPI: 1740468396
Provider Name (Legal Business Name): CARDIAC & VASCULAR SURGERY SPECIALIST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 64TH TERR. STE A
GAINESVILLE FL
32605
US

IV. Provider business mailing address

1121 NW 64TH TERR. 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 TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ELMER E. CROUSHORE III
Title or Position: OWNER
Credential: MD
Phone: 352-331-6777