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General NPI Number Information
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NPI Number | 1245200906
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Entity Type | Individual
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Provider Name | GODSON IFEANYI OGUCHI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 955 TOWN CENTER DR SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8255
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Country | US
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Telephone | 386-228-0661
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Fax | 386-228-0662
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Provider Business Mailing Address
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Address Line | PO BOX 471027
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City | LAKE MONROE
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State | FL
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Zip | 32747-1027
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Country | US
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Telephone | 386-228-0661
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Fax | 386-228-0662
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME89341
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME89341
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License Number State | FL
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