Provider Demographics
NPI:1770707838
Name:QUMSEYA, BASHAR JERYES (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:JERYES
Last Name:QUMSEYA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100214
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0214
Mailing Address - Country:US
Mailing Address - Phone:352-273-9500
Mailing Address - Fax:352-627-4179
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4840
Practice Address - Country:US
Practice Address - Phone:352-273-9500
Practice Address - Fax:352-273-9500
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106681207R00000X, 207RG0100X
GA071619207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002469500Medicaid
FLDK305ZMedicare PIN