Healthcare Provider Details

I. General information

NPI: 1053328518
Provider Name (Legal Business Name): JOHN ALAN PRIOR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD VAMC
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

5804 NW 62ND CT
GAINESVILLE FL
32653-3201
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-7420
Mailing address:
  • Phone: 352-374-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: