Healthcare Provider Details

I. General information

NPI: 1245478452
Provider Name (Legal Business Name): TERI SPEED CUMPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERI S GORE MD

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SW 87TH PL
OCALA FL
34476-6716
US

IV. Provider business mailing address

2101 SW 87TH PL
OCALA FL
34476-6716
US

V. Phone/Fax

Practice location:
  • Phone: 352-266-5000
  • Fax:
Mailing address:
  • Phone: 352-266-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number66357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD.09203R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number66357
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number66357
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number66357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: