Healthcare Provider Details

I. General information

NPI: 1780048900
Provider Name (Legal Business Name): ISAAC LURIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 10024
GAINESVILLE FL
32610-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0077
  • Fax: 352-392-7029
Mailing address:
  • Phone: 352-273-8610
  • Fax: 352-392-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME143847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: