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Individual

MR. JESSE A. KANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-2230
(352) 273-7584
(352) 392-3498
Mailing address
PO BOX 100294, GAINESVILLE, FL 32610-0294
(352) 273-7584
(352) 392-3498

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
059536
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
ME36705
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
059536
PHYSICIAN LICENSE
GA
05
104837400
FL
01
11D0941435
CLIA ID -2010 OCILLA RD
GA
01
11D1105865
CLIA ID - 17 JOHNSON ST
GA
05
234608607A
GA
05
234608607B
GA
01
421005
WELLCARE OF GA
01
DH1281
RAILROAD MEDICARE - GROUP #
GA
01
P00787893
RAILROAD MEDICARE - PTAN
GA
Enumeration date
07/13/2005
Last updated
03/07/2023
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