Healthcare Provider Details

I. General information

NPI: 1568785012
Provider Name (Legal Business Name): SCOLA PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 NW 53RD AVE
GAINESVILLE FL
32653-4885
US

IV. Provider business mailing address

PO BOX 147050 PMB 515
GAIENSVILLE FL
32614-4885
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-0094
  • Fax: 352-375-1677
Mailing address:
  • Phone: 352-264-0094
  • Fax: 352-375-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP02981
License Number StateFL

VIII. Authorized Official

Name: DR. JERE A SCOLA III
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 352-264-0094