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General NPI Number Information
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NPI Number | 1932119963
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Entity Type | Organization
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Legal Business Name | DOCTORS IMAGING GROUP LLC PUTNAM RADIOLOGY OFFICE
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6121 SAINT JOHNS AVE
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City | PALATKA
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State | FL
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Zip | 32177-3889
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Country | US
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Telephone | 386-326-0077
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Fax | 386-326-0188
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Provider Business Mailing Address
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Address Line | PO BOX 147026
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City | GAINESVILLE
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State | FL
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Zip | 32614-7026
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Country | US
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Telephone | 386-326-0077
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Fax | 386-326-0188
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Authorized Official
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Title or Position | PRESIDENT/ PRACTICING PHYSICIAN
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Name | DR. DAN E. WARE
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Credential | M.D.
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Telephone | 352-331-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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