Provider Demographics
NPI:1730195256
Name:GINDOFF, ALAN F (PA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:F
Last Name:GINDOFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:FREDERICK
Other - Last Name:GINDOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-463-7980
Practice Address - Fax:352-265-7996
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291304600Medicaid
U1459YMedicare PIN
FLE8211XMedicare PIN
FL291304600Medicaid
FLS10775Medicare UPIN