Basic Information
| Provider Information | |||||||||
| NPI: | 1255305645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH FLORIDA WOMENS PHYSICIANS P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6440 W NEWBERRY RD | ||||||||
| Address2: | STE 508 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523327222 | ||||||||
| FaxNumber: | 3523327330 | ||||||||
| Practice Location | |||||||||
| Address1: | 6440 W NEWBERRY RD | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523327222 | ||||||||
| FaxNumber: | 3523327330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 11/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3523327222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 261478200 | 05 | FL | MEDICAID |