Provider Demographics
NPI:1992995914
Name:CLARENCE NELSON UY M D P A
Entity type:Organization
Organization Name:CLARENCE NELSON UY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:352-222-4235
Mailing Address - Street 1:5217 SW 97TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4151
Mailing Address - Country:US
Mailing Address - Phone:352-222-4235
Mailing Address - Fax:
Practice Address - Street 1:3720 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-336-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31574CMedicare PIN