Basic Information
| Provider Information | |||||||||
| NPI: | 1417498031 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIMARY CARE PHYSICIANS OF GAINESVILLE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3780 NW 83RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326065603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523772022 | ||||||||
| FaxNumber: | 3523779113 | ||||||||
| Practice Location | |||||||||
| Address1: | 3780 NW 83RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326065603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523772022 | ||||||||
| FaxNumber: | 3523779113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2017 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | BLAYLOCK | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3523772022 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | ARNP9391209 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.