Provider Demographics
NPI:1770298341
Name:GWINN, DESIRAE (RT(R)(MR))
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:GWINN
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Gender:F
Credentials:RT(R)(MR)
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4340 NEWBERRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2557
Mailing Address - Country:US
Mailing Address - Phone:352-377-3100
Mailing Address - Fax:
Practice Address - Street 1:4340 NEWBERRY RD STE 104
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2557
Practice Address - Country:US
Practice Address - Phone:352-377-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL90322207RM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)