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General NPI Number Information
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NPI Number | 1508869405
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Entity Type | Organization
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Legal Business Name | GAINESVILLE RADIOLOGY GROUP WEST, LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4960 W NEWBERRY RD STE 280
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City | GAINESVILLE
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State | FL
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Zip | 32607-2201
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Country | US
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Telephone | 352-371-3336
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Fax | 352-371-3372
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Provider Business Mailing Address
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Address Line | 4960 W NEWBERRY RD STE 280
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City | GAINESVILLE
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State | FL
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Zip | 32607-2201
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Country | US
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Telephone | 352-371-3336
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Fax | 352-371-3372
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TONY ARVESU
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Credential |
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Telephone | 352-332-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 256176
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License Number State | FL
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