Basic Information
Provider Information
NPI: 1740236330
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VANROY
FirstName: DANIEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4645 NW 8TH AVE
Address2: INTERVENTIONAL CARDIOLOGISTS OF GAINESVILLE
City: GAINESVILLE
State: FL
PostalCode: 326054524
CountryCode: US
TelephoneNumber: 3522642500
FaxNumber: 3523319095
Practice Location
Address1: 4645 NW 8TH AVE
Address2: INTERVENTIONAL CARDIOLOGISTS OF GAINESVILLE
City: GAINESVILLE
State: FL
PostalCode: 326054524
CountryCode: US
TelephoneNumber: 3522642500
FaxNumber: 3523319095
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 04/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XME77995FLY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XME77995FLN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
25642540005FL MEDICAID
4654301FLBLUECROSS FLOTHER
CM855001FLMEDICARE RROTHER


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