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General NPI Number Information
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NPI Number | 1851619993
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Entity Type | Individual
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Provider Name | ELEAZAR DOMINGO FARISCAL DO, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-4638
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Country | US
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Telephone | 352-757-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 9005 SW 70TH LN
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City | GAINESVILLE
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State | FL
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Zip | 32608-5394
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Country | US
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Telephone | 248-205-0575
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11023156A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS21335
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License Number State | FL
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