Provider Demographics
NPI:1891565826
Name:EXPRESS PRIMARY CARE OF OCALA
Entity Type:Organization
Organization Name:EXPRESS PRIMARY CARE OF OCALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-732-9888
Mailing Address - Street 1:1834 SW 1ST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8102
Mailing Address - Country:US
Mailing Address - Phone:352-732-9888
Mailing Address - Fax:352-732-0490
Practice Address - Street 1:1834 SW 1ST AVE STE 201
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8102
Practice Address - Country:US
Practice Address - Phone:352-732-9888
Practice Address - Fax:352-732-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty