Organization
GAINESVILLE UROLOGY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARK DALE GADDY M.D. (PRESIDENT)
(352) 373-6338
Entity
Organization
Contact information
Practice address
4881 NW 8TH AVE, SUITE 2, GAINESVILLE, FL 32605-4582
(352) 373-6338
(352) 373-6144
Mailing address
4881 NW 8TH AVE, SUITE 2, GAINESVILLE, FL 32605-4582
(352) 373-6338
(352) 373-6144
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME0048155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43583
BCBS FL GROUP NUMBER
FL
Enumeration date
09/16/2006
Last updated
08/22/2020
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