Healthcare Provider Details

I. General information

NPI: 1508487307
Provider Name (Legal Business Name): TOMER KEIDAN MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

1700 SW 16TH CT
GAINESVILLE FL
32608-1516
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0916
  • Fax:
Mailing address:
  • Phone: 352-256-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: