MEDICARE: LAWRENCE OGAGAOGHENE ADU 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
1	2084N0400X	Neurology Physician	ME84024	FL
2	2084P0800X	Psychiatry Physician	ME84024	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	28806	OTHER		BCBS

General Provider Information

NPI Number	:	1679597702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE OGAGAOGHENE ADU MD

Provider Business Mailing Address
First Line	:	1103 SW 2ND AVE STE C
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-6116
Country	:	US
Telephone Number	:	352-378-9116
Fax Number	:	352-378-9779

Provider Business Practice Location Address
First Line	:	1103 SW 2ND AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-6116
Country	:	US
Telephone Number	:	352-378-9116
Fax Number	:	352-378-9779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/17/2018

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