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General NPI Number Information
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NPI Number | 1811449879
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Entity Type | Organization
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Legal Business Name | TOWN CENTER RESEARCH AND WALK-IN CLINIC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 955 TOWN CENTER DR SUITE 200
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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 | 407-435-9075
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Fax | 386-822-4192
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Provider Business Mailing Address
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Address Line | 330 MARKHAM WOODS RD
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City | LONGWOOD
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State | FL
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Zip | 32779-2830
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Country | US
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Telephone | 407-435-9075
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Fax | 386-822-4192
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Authorized Official
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Title or Position | PRESIDENT
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Name | GODSON I OGUCHI
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Credential | MD
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Telephone | 407-435-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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