Provider Demographics
NPI:1396864708
Name:GAINESVILLE ENDOCRINE & DIABETES ASSOCIATES PA
Entity Type:Organization
Organization Name:GAINESVILLE ENDOCRINE & DIABETES ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:I
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:352-333-5440
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-5440
Mailing Address - Fax:352-333-5272
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-333-5440
Practice Address - Fax:352-333-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70458207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31317Medicare ID - Type Unspecified
FLC17554Medicare UPIN