Basic Information
| Provider Information | |||||||||
| NPI: | 1750673547 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOLLACCIO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 KILGORE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328365523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072301495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3450 HULL RD | ||||||||
| Address2: | STE 3301 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326074144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522737394 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | TRN# 15911 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.