Healthcare Provider Details

I. General information

NPI: 1306905948
Provider Name (Legal Business Name): OCALA HAND CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 SW 32ND PLACE
OCALA FL
34471-7847
US

IV. Provider business mailing address

PO BOX 9074
BELFAST ME
04915-9074
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-1099
  • Fax: 352-369-0299
Mailing address:
  • Phone: 352-369-1099
  • Fax: 352-369-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS9484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberOS9535
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3280
License Number StateFL

VIII. Authorized Official

Name: DR. NIRAV GUPTA
Title or Position: PRINCIPAL
Credential: D.O.
Phone: 352-369-1099