Provider Demographics
NPI:1750355830
Name:PULMONARY PHYSICIANS OF GAINESVILLE, PA
Entity type:Organization
Organization Name:PULMONARY PHYSICIANS OF GAINESVILLE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:TONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-375-0302
Mailing Address - Street 1:4741 NW 8TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5511
Mailing Address - Country:US
Mailing Address - Phone:352-375-0302
Mailing Address - Fax:352-371-0456
Practice Address - Street 1:4711 NW 8TH AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-375-0302
Practice Address - Fax:352-371-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043168207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45768OtherBCBS
FL270931700Medicaid
FLK3010Medicare ID - Type Unspecified