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General NPI Number Information
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NPI Number | 1780709998
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Entity Type | Organization
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Legal Business Name | INNOCENT ODOCHA MD PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 816 NW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32601-2903
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Country | US
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Telephone | 352-371-3212
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Fax | 352-371-3213
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Provider Business Mailing Address
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Address Line | 816 NW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32601-2903
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Country | US
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Telephone | 352-371-3212
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Fax | 352-371-3213
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. INNOCENT ODOCHA
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Credential | MD
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Telephone | 352-371-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME86683
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License Number State | FL
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