Provider Demographics
NPI:1134179989
Name:DOCTORS IMAGING GROUP LLC
Entity type:Organization
Organization Name:DOCTORS IMAGING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:6716 NW 11TH PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4215
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:6716 NW 11TH PL STE 200
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4201
Practice Address - Country:US
Practice Address - Phone:352-331-9729
Practice Address - Fax:352-331-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259303305Medicaid
FL259303300Medicaid
FL259303304Medicaid
FLV2766OtherBCBSFL
FL259303301Medicaid
FL270855OtherAVMED
FLCK3155OtherRRMCARE
FL259303303Medicaid
FL45280OtherFL BCBS
FL259303306Medicaid
FL45280OtherBCBSFL
FL017050900Medicaid
FLCK3155OtherRAILROAD MEDICARE
FL45280OtherBCBSFL
FLCK3155OtherRAILROAD MEDICARE