Provider Demographics
NPI:1275710758
Name:OGBURIA, KEMKA S JR (MD)
Entity Type:Individual
Prefix:
First Name:KEMKA
Middle Name:S
Last Name:OGBURIA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-332-8080
Mailing Address - Fax:407-260-0602
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 210
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-332-8080
Practice Address - Fax:407-260-0602
Is Sole Proprietor?:No
Enumeration Date:2008-01-27
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101561174400000X, 207ND0101X
IL036118526207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No174400000XOther Service ProvidersSpecialist