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General NPI Number Information
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NPI Number | 1720248347
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Entity Type | Organization
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Legal Business Name | AMERICAN FAMILY MEDICAL LLC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 1750 SE 28TH LOOP
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City | OCALA
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State | FL
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Zip | 34471-1080
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Country | US
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Telephone | 352-351-4634
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Fax | 352-351-1900
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Provider Business Mailing Address
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Address Line | 1750 SE 28TH LOOP
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City | OCALA
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State | FL
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Zip | 34471-1080
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Country | US
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Telephone | 352-351-4634
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Fax | 352-351-1900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LUCIOUS OLIVER
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Credential | DO
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Telephone | 352-351-4634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7024
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License Number State | FL
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