Healthcare Provider Details

I. General information

NPI: 1295768398
Provider Name (Legal Business Name): DEARDOURFF TIMMONS & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 NW 9TH BLVD
GAINESVILLE FL
32605-4203
US

IV. Provider business mailing address

6420 NW 9TH BLVD
GAINESVILLE FL
32605-4203
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2332
  • Fax: 352-331-6515
Mailing address:
  • Phone: 352-331-2332
  • Fax: 352-331-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME79809
License Number StateFL

VIII. Authorized Official

Name: CHRISTOPHER M CASSISI
Title or Position: SECRETARY
Credential: MD
Phone: 352-331-2332