Provider Demographics
NPI:1932119963
Name:DOCTORS IMAGING GROUP LLC PUTNAM RADIOLOGY OFFICE
Entity Type:Organization
Organization Name:DOCTORS IMAGING GROUP LLC PUTNAM RADIOLOGY OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PRACTICING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-9729
Mailing Address - Street 1:PO BOX 147026
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-7026
Mailing Address - Country:US
Mailing Address - Phone:386-326-0077
Mailing Address - Fax:386-326-0188
Practice Address - Street 1:6121 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3889
Practice Address - Country:US
Practice Address - Phone:386-326-0077
Practice Address - Fax:386-326-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270855OtherAVMED GROUP
FLV2766OtherBC IDTF
FLCK3155OtherRRMC GROUP
FL45280OtherBC GROUP
FLCK3155OtherRRMC GROUP
FLCK3155OtherRRMC GROUP
FL45280Medicare ID - Type UnspecifiedGROUP