Healthcare Provider Details

I. General information

NPI: 1164597662
Provider Name (Legal Business Name): MICHAEL B ROZBORIL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 NW 8TH AVE SUITE A
GAINESVILLE FL
32605-5511
US

IV. Provider business mailing address

4741 NW 8TH AVE SUITE A
GAINESVILLE FL
32605-5511
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-9790
  • Fax: 352-337-0744
Mailing address:
  • Phone: 352-374-9790
  • Fax: 352-337-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number833592
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0046253
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL BOZETECH ROZBORIL
Title or Position: PRESIDENT
Credential: MD
Phone: 352-374-9790