Provider Demographics
NPI:1093169864
Name:MEDICAL MANAGEMENT OF OCALA
Entity Type:Organization
Organization Name:MEDICAL MANAGEMENT OF OCALA
Other - Org Name:OCALA EAR, NOSE & THROAT SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-5042
Mailing Address - Street 1:2120 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7765
Mailing Address - Country:US
Mailing Address - Phone:352-732-5042
Mailing Address - Fax:352-732-6031
Practice Address - Street 1:2120 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7765
Practice Address - Country:US
Practice Address - Phone:352-732-5042
Practice Address - Fax:352-732-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9319416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty