Provider Demographics
NPI:1568449254
Name:GROOMS, MARY CLARKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLARKE
Last Name:GROOMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:STE 402
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-5500
Mailing Address - Fax:352-333-5506
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:STE 402
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-5500
Practice Address - Fax:352-332-5506
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME842592080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266131400Medicaid
28007YMedicare PIN
H78261Medicare UPIN
FL28007XMedicare PIN