Healthcare Provider Details

I. General information

NPI: 1629058656
Provider Name (Legal Business Name): CHRISTOPHER P OGRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY SUITE 200
GULF BREEZE FL
32561-7809
US

IV. Provider business mailing address

1040 GULF BREEZE PKWY SUITE 200
GULF BREEZE FL
32561-7809
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-3700
  • Fax: 850-916-3710
Mailing address:
  • Phone: 850-916-3700
  • Fax: 850-916-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 87161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: