Individual
DR. BAHAREH EBADIFAR KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-0462
(352) 273-6250
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 273-0462
(352) 273-6250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS10957
FL
208000000X
Pediatrics Physician
UO1652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002398600
—
FL
Enumeration date
06/21/2007
Last updated
09/24/2010
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