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NPI Code Detail

MEDICARE: DR. JOHN P OUDERKIRK MD

MEDICARE: DR. JOHN P OUDERKIRK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0200XInfectious Disease Physician049992GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4440003559OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1453538OTHERGACHAMPUS
27439283OTHERGAUS HEALTH
38625897001OTHERGACIGNA HMO
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
62647814OTHERGAAETNA HMO
77439283OTHERGAAETNA

General Provider Information

NPI Number : 1548260508
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN P OUDERKIRK MD
Provider Business Mailing Address
First Line : 8390 CHAMPIONS GATE BLVD
Second Line : SUITE 215
City : CHAMPIONS GATE
State : FL
Zip : 33896-8310
Country : US
Telephone Number : 407-390-1677
Fax Number : 407-390-1765
Provider Business Practice Location Address
First Line : 735 PIEDMONT AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30308-1416
Country : US
Telephone Number : 404-588-4680
Fax Number : 404-588-4692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/27/2016

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Directions to “ DR. JOHN P OUDERKIRK MD” Practice Location

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