Basic Information
| Provider Information | |||||||||
| NPI: | 1134179989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS IMAGING GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6716 NW 11TH PLACE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523319729 | ||||||||
| FaxNumber: | 3523310136 | ||||||||
| Practice Location | |||||||||
| Address1: | 6716 NW 11TH PLACE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523319729 | ||||||||
| FaxNumber: | 3523310136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | WARE | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3523319729 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 45280 | 01 | FL | FL BCBS | OTHER | CK3155 | 01 | FL | RRMCARE | OTHER | CK3155 | 01 | FL | RAILROAD MEDICARE | OTHER | 259303301 | 05 | FL | MEDICAID | 259303303 | 05 | FL | MEDICAID | 259303306 | 05 | FL | MEDICAID | 270855 | 01 | FL | AVMED | OTHER | 45280 | 01 | FL | BCBSFL | OTHER | 259303305 | 05 | FL | MEDICAID | 017050900 | 05 | FL | MEDICAID | V2766 | 01 | FL | BCBSFL | OTHER | 259303300 | 05 | FL | MEDICAID | 259303304 | 05 | FL | MEDICAID |