Provider Demographics
NPI:1679597702
Name:ADU, LAWRENCE OGAGAOGHENE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:OGAGAOGHENE
Last Name:ADU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1103 SW 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6116
Mailing Address - Country:US
Mailing Address - Phone:352-378-9116
Mailing Address - Fax:352-378-9779
Practice Address - Street 1:1103 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6116
Practice Address - Country:US
Practice Address - Phone:352-378-9116
Practice Address - Fax:352-378-9779
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME840242084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274635200Medicaid
28806OtherBCBS
FL274635200Medicaid
28806OtherBCBS