Basic Information
| Provider Information | |||||||||
| NPI: | 1285930727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN FAMILY MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 SE 16TH AVE | ||||||||
| Address2: | SUTIE 1201 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523514634 | ||||||||
| FaxNumber: | 3513511900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1805 SE 16TH AVE | ||||||||
| Address2: | SUTIE 1201 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523514634 | ||||||||
| FaxNumber: | 3513511900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2011 | ||||||||
| LastUpdateDate: | 02/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | OLIVER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3523514634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.