Provider Demographics
NPI:1942706551
Name:LONDON, HEATHER N (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:N
Other - Last Name:BRUNGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4852
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:3304 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3357
Practice Address - Country:US
Practice Address - Phone:352-401-7575
Practice Address - Fax:352-401-7577
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52636207Q00000X
FLME149376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110632300Medicaid