Provider Demographics
NPI:1477719763
Name:INNOCENT ODOCHA, M.D.,P.A.
Entity Type:Organization
Organization Name:INNOCENT ODOCHA, M.D.,P.A.
Other - Org Name:ODOCHA FAMILY MEDICINE AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-3212
Mailing Address - Street 1:1026 SW 2ND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6134
Mailing Address - Country:US
Mailing Address - Phone:352-371-3212
Mailing Address - Fax:
Practice Address - Street 1:1026 SW 2ND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6134
Practice Address - Country:US
Practice Address - Phone:352-371-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty