Healthcare Provider Details

I. General information

NPI: 1033751250
Provider Name (Legal Business Name): OCEANS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 LEE RD STE 100
WINTER PARK FL
32789-2214
US

IV. Provider business mailing address

1404 N RONALD REAGAN BLVD UNIT 1120
LONGWOOD FL
32750-3410
US

V. Phone/Fax

Practice location:
  • Phone: 407-413-8883
  • Fax: 407-413-8892
Mailing address:
  • Phone: 407-413-8883
  • Fax: 407-413-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEYNE JOHNSON
Title or Position: OWNER
Credential: MD
Phone: 407-413-8883