Healthcare Provider Details

I. General information

NPI: 1841297538
Provider Name (Legal Business Name): OCALA ORTHOPAEDIC GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SE 17TH ST STE 100
OCALA FL
34471-3920
US

IV. Provider business mailing address

1015 SE 17TH ST #100
OCALA FL
34471-3968
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3422
  • Fax: 352-351-9129
Mailing address:
  • Phone: 352-401-3127
  • Fax: 352-351-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY PAMELA REGISTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-401-3127