Provider Demographics
NPI:1710050596
Name:GAINESVILLE PEDIATRIC ASSOCIATES INC
Entity Type:Organization
Organization Name:GAINESVILLE PEDIATRIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-333-5500
Mailing Address - Street 1:6440 W NEWBERRY ROAD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-333-5500
Mailing Address - Fax:352-333-5506
Practice Address - Street 1:6440 W NEWBERRY ROAD
Practice Address - Street 2:SUITE 402
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-333-5500
Practice Address - Fax:352-333-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty