Provider Demographics
NPI:1558371625
Name:DOCTORS IMAGING GROUP, LLC EAST OFFICE
Entity Type:Organization
Organization Name:DOCTORS IMAGING GROUP, LLC EAST OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTICING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-9729
Mailing Address - Street 1:PO BOX 147026
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-7026
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:1026 SW 2ND AVE STE F
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8182
Practice Address - Country:US
Practice Address - Phone:352-377-7120
Practice Address - Fax:352-377-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45280OtherBC GROUP
FLV2766OtherBC IDTF
FL270855OtherAVMED GROUP
FLCK3155OtherRRMC GROUP
FLV2766OtherBC IDTF
FL45280Medicare ID - Type UnspecifiedGROUP
FLE4432Medicare ID - Type UnspecifiedIDTF