Basic Information
| Provider Information | |||||||||
| NPI: | 1134546542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THORACIC AND VASCULAR SURGEONS OF GAINESVILLE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14655 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326044655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523319095 | ||||||||
| FaxNumber: | 3523319095 | ||||||||
| Practice Location | |||||||||
| Address1: | 1151 NW 64TH TER | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523318570 | ||||||||
| FaxNumber: | 3523319095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | PROIA | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3524162628 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME94028 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | ME94028 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.