Healthcare Provider Details

I. General information

NPI: 1609316975
Provider Name (Legal Business Name): GAINESVILLE MEDICAL OBESITY SPECIALTY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 NW 11TH PL SUITE A
GAINESVILLE FL
32605-4254
US

IV. Provider business mailing address

6830 NW 11TH PL SUITE A
GAINESVILLE FL
32605-4254
US

V. Phone/Fax

Practice location:
  • Phone: 352-672-9000
  • Fax: 352-505-8552
Mailing address:
  • Phone: 352-672-9000
  • Fax: 352-505-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME0054910
License Number StateFL

VIII. Authorized Official

Name: DR. CINDI LYNN LARIMER
Title or Position: OWNER/MANAGER
Credential: M.D.
Phone: 352-672-9000