Healthcare Provider Details

I. General information

NPI: 1942706551
Provider Name (Legal Business Name): HEATHER N LONDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER N BRUNGES

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 SW 34TH CIRCLE SUITE 103
OCALA FL
34474-3357
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4852
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-7575
  • Fax: 352-401-7577
Mailing address:
  • Phone: 352-416-1082
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52636
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME149376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: