Healthcare Provider Details

I. General information

NPI: 1912322934
Provider Name (Legal Business Name): OAKWOOD FAMILY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OAKWOOD DR SUITE 202
OCALA FL
34472-2137
US

IV. Provider business mailing address

200 OAKWOOD DR SUITE 202
OCALA FL
34472-2137
US

V. Phone/Fax

Practice location:
  • Phone: 352-687-8099
  • Fax: 352-687-3646
Mailing address:
  • Phone: 352-687-8099
  • Fax: 352-687-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0069694
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME 69694
License Number StateFL

VIII. Authorized Official

Name: HENRIOT JEAN-BAPTISTE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 352-687-8099