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General NPI Number Information
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NPI Number | 1073874145
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Entity Type | Organization
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Legal Business Name | OMNICARE MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 1805 W COLONIAL DR SUITE A
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City | ORLANDO
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State | FL
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Zip | 32804-7013
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Country | US
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Telephone | 407-578-9142
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Fax | 407-578-8616
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Provider Business Mailing Address
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Address Line | 1805 W COLONIAL DR SUITE A
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City | ORLANDO
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State | FL
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Zip | 32804-7013
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Country | US
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Telephone | 407-578-9142
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Fax | 407-578-8616
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | OWEN D FRASER
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Credential | MD
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Telephone | 407-578-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME30256
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License Number State | FL
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