Provider Demographics
NPI:1568189728
Name:SYNCHRONY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SYNCHRONY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-267-7446
Mailing Address - Street 1:7328 W UNIVERSITY AVE STE E
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1635
Mailing Address - Country:US
Mailing Address - Phone:352-225-3976
Mailing Address - Fax:352-554-5092
Practice Address - Street 1:7328 W UNIVERSITY AVE STE E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1635
Practice Address - Country:US
Practice Address - Phone:352-225-3976
Practice Address - Fax:352-554-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty