Provider Demographics
NPI:1972828861
Name:RICHARD GORENBERG, MD, PA
Entity Type:Organization
Organization Name:RICHARD GORENBERG, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GORENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-372-3511
Mailing Address - Street 1:3601 SW 2ND AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2865
Mailing Address - Country:US
Mailing Address - Phone:352-372-3511
Mailing Address - Fax:352-372-3513
Practice Address - Street 1:3601 SW 2ND AVE
Practice Address - Street 2:SUITE J
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2865
Practice Address - Country:US
Practice Address - Phone:352-372-3511
Practice Address - Fax:352-372-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11670207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50006Medicare UPIN
FL01178Medicare PIN