Provider Demographics
NPI:1659567303
Name:GAINESVILLE PLASTIC SURGERY ASSOCIATES PL
Entity Type:Organization
Organization Name:GAINESVILLE PLASTIC SURGERY ASSOCIATES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-3401
Mailing Address - Street 1:6801 NW 9TH BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4269
Mailing Address - Country:US
Mailing Address - Phone:352-331-3401
Mailing Address - Fax:352-332-0922
Practice Address - Street 1:6801 NW 9TH BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4269
Practice Address - Country:US
Practice Address - Phone:352-331-3401
Practice Address - Fax:352-332-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty