Active NPI
Michael Douglas Autry
- Radiologic Technologist
- Gainesville, FL
National Provider Identifier
1336497841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- CRT82679
- Practice address
- 1601 SW Archer Rd
Gainesville, FL 32608-1135 - Phone
- (352) 271-5000
- NPI assigned
- Aug 15, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | CRT82679 | FL | Primary |
Addresses
Primary practice location
1601 SW Archer Rd
Gainesville, FL 32608-1135
Mailing address
7927 SW 13TH Rd
Gainesville, FL 32607-3320
Phone (352) 328-9830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CRT82679 | FL | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344988800000",
"number": "1336497841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7927 SW 13TH RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326073320",
"telephone_number": "352-328-9830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081135",
"telephone_number": "352-271-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUTRY",
"first_name": "MICHAEL",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-15",
"last_updated": "2012-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "FL",
"license": "CRT82679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.