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General NPI Number Information
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NPI Number | 1548935216
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH LAVERY MD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 4037 NW 86TH TER FL 4
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City | GAINESVILLE
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State | FL
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Zip | 32606-9277
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Country | US
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Telephone | 352-594-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 4037 NW 86TH TER FL 4
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City | GAINESVILLE
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State | FL
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Zip | 32606-9277
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Country | US
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Telephone | 352-594-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 65654
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME160236
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License Number State | FL
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