Provider Demographics
NPI:1245541135
Name:GERIATRICS ASSOCIATES OF GAINESVILLE INC
Entity type:Organization
Organization Name:GERIATRICS ASSOCIATES OF GAINESVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUDDUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-367-9700
Mailing Address - Street 1:PO BOX 141450
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-1450
Mailing Address - Country:US
Mailing Address - Phone:352-367-9700
Mailing Address - Fax:352-367-1009
Practice Address - Street 1:6711 MILLHOPPER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3944
Practice Address - Country:US
Practice Address - Phone:352-367-9700
Practice Address - Fax:352-367-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD1049AMedicare PIN