=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942706551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER N LONDON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2018
-----------------------------------------------------
Last Update Date | 08/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3304 SW 34TH CIRCLE SUITE 103
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-401-7575
-----------------------------------------------------
Fax | 352-401-7577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4881 NW 8TH AVE SUITE 2
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32605-4852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-416-1082
-----------------------------------------------------
Fax | 352-373-6144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 52636
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME149376
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------