Healthcare Provider Details

I. General information

NPI: 1730105818
Provider Name (Legal Business Name): ALEXANDER GOMELSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF UROLOGY
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax:
Mailing address:
  • Phone: 318-813-2750
  • Fax: 318-813-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number15563R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME170873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: