Provider Demographics
NPI:1619125390
Name:GOLOFF, JACK M (DO)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:GOLOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2443
Mailing Address - Country:US
Mailing Address - Phone:954-263-3399
Mailing Address - Fax:954-493-8889
Practice Address - Street 1:304 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2443
Practice Address - Country:US
Practice Address - Phone:954-263-3399
Practice Address - Fax:954-493-8889
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8194208VP0000X
FL8491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID27397Medicare UPIN