Healthcare Provider Details

I. General information

NPI: 1891589842
Provider Name (Legal Business Name): BRICE BLAND SEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

204 S COOLIDGE AVE
TAMPA FL
33609-3828
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5549
  • Fax:
Mailing address:
  • Phone: 813-347-8771
  • 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: