Provider Demographics
NPI:1578601464
Name:OCALA PEDIATRICS LLC
Entity Type:Organization
Organization Name:OCALA PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-8955
Mailing Address - Street 1:1500 SE 17TH ST
Mailing Address - Street 2:#600
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4621
Mailing Address - Country:US
Mailing Address - Phone:352-732-8955
Mailing Address - Fax:
Practice Address - Street 1:1500 SE 17TH ST
Practice Address - Street 2:#600
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4621
Practice Address - Country:US
Practice Address - Phone:352-732-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty