Provider Demographics
NPI:1215214259
Name:JOHN A DRYFUSS JR MD PA
Entity Type:Organization
Organization Name:JOHN A DRYFUSS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRYFUSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD PA
Authorized Official - Phone:352-331-1773
Mailing Address - Street 1:7109 NW 11TH PL
Mailing Address - Street 2:STE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3170
Mailing Address - Country:US
Mailing Address - Phone:352-331-1773
Mailing Address - Fax:352-331-1814
Practice Address - Street 1:7109 NW 11TH PL
Practice Address - Street 2:STE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3170
Practice Address - Country:US
Practice Address - Phone:352-331-1773
Practice Address - Fax:352-331-1814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN A DRYFUSS JR MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015017207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0355799500Medicaid
FL0355799500Medicaid
01217Medicare PIN