Healthcare Provider Details

I. General information

NPI: 1386674539
Provider Name (Legal Business Name): CRISTOFORO LOUIS-VINCENT CAMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5400
  • Fax: 352-333-5404
Mailing address:
  • Phone: 352-373-6338
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0074128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: