Provider Demographics
NPI:1528276466
Name:GAINESVILLE PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:GAINESVILLE PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BERENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-331-4333
Mailing Address - Street 1:915 NW 56TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6408
Mailing Address - Country:US
Mailing Address - Phone:352-331-4333
Mailing Address - Fax:352-331-8382
Practice Address - Street 1:915 NW 56TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6408
Practice Address - Country:US
Practice Address - Phone:352-331-4333
Practice Address - Fax:352-331-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1560213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63932Medicare UPIN
FL87868YMedicare ID - Type Unspecified