Healthcare Provider Details

I. General information

NPI: 1326256470
Provider Name (Legal Business Name): JOHN W TYRONE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NW 76TH DR STE A STE F
GAINESVILLE FL
32607-6652
US

IV. Provider business mailing address

108 NW 76TH DR STE A STE F
GAINESVILLE FL
32607-6652
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-1150
  • Fax: 352-332-1044
Mailing address:
  • Phone: 352-332-1150
  • Fax: 352-332-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME89702
License Number StateFL

VIII. Authorized Official

Name: MRS. CHERYL C TYRONE
Title or Position: CO-OWNER
Credential:
Phone: 352-332-1150