Healthcare Provider Details

I. General information

NPI: 1528276466
Provider Name (Legal Business Name): GAINESVILLE PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 NW 56TH TER
GAINESVILLE FL
32605-6408
US

IV. Provider business mailing address

915 NW 56TH TER
GAINESVILLE FL
32605-6408
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-4333
  • Fax: 352-331-8382
Mailing address:
  • Phone: 352-331-4333
  • Fax: 352-331-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 1560
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS ANTHONY BERENS
Title or Position: OWNER
Credential: DPM
Phone: 352-331-4333