Healthcare Provider Details

I. General information

NPI: 1285930727
Provider Name (Legal Business Name): AMERICAN FAMILY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 SE 16TH AVE SUTIE 1201
OCALA FL
34471-4672
US

IV. Provider business mailing address

1805 SE 16TH AVE SUTIE 1201
OCALA FL
34471-4672
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-4634
  • Fax: 351-351-1900
Mailing address:
  • Phone: 352-351-4634
  • Fax: 351-351-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID L OLIVER
Title or Position: PRESIDENT
Credential: DO
Phone: 352-351-4634