Provider Demographics
NPI:1144394362
Name:GAINESVILLE OTOLARYNGOLOGY GRP
Entity Type:Organization
Organization Name:GAINESVILLE OTOLARYNGOLOGY GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERSHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-6700
Mailing Address - Street 1:6821 NW 11 PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-6700
Mailing Address - Fax:352-332-0890
Practice Address - Street 1:6821 NW 11 PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-6700
Practice Address - Fax:352-332-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0038170207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79596XMedicare ID - Type Unspecified
D58851Medicare UPIN