Healthcare Provider Details

I. General information

NPI: 1649802109
Provider Name (Legal Business Name): OCALA SPINE & INJURY SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 SE 17TH ST
OCALA FL
34471-4607
US

IV. Provider business mailing address

1541 SE 17TH ST
OCALA FL
34471-4607
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5590
  • Fax: 352-732-0292
Mailing address:
  • Phone: 352-732-5590
  • Fax: 352-732-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN MARYLAND WALKER
Title or Position: OWNER
Credential: DC
Phone: 352-732-5590