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Individual

DIMA EZMIGNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1600 SW ARCHER RD, BOX 100296, GAINESVILLE, FL 32610-3003
(352) 273-5824
Mailing address
1600 SW ARCHER RD, BOX 100296, GAINESVILLE, FL 32610-3003

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
TRN19338
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
015046500
FL
Enumeration date
02/04/2014
Last updated
07/16/2015
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