Healthcare Provider Details

I. General information

NPI: 1669733986
Provider Name (Legal Business Name): DON HENRY ESPRIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SW STONEGATE TER STE 105
LAKE CITY FL
32024-3463
US

IV. Provider business mailing address

221 SW STONEGATE TER STE 105
LAKE CITY FL
32024-3463
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-6107
  • Fax: 386-755-6950
Mailing address:
  • Phone: 386-752-6107
  • Fax: 386-755-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME130397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: