Basic Information
| Provider Information | |||||||||
| NPI: | 1649293648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE PHYSICIANS OF GAINESVILLE, P.A. | ||||||||
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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: | 32606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523772022 | ||||||||
| FaxNumber: | 3523779113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | ENTREKIN | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3523772022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 016400509 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.