Provider Demographics
NPI:1720248347
Name:AMERICAN FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LUCIOUS
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-351-4634
Mailing Address - Street 1:1750 SE 28TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1080
Mailing Address - Country:US
Mailing Address - Phone:352-351-4634
Mailing Address - Fax:352-351-1900
Practice Address - Street 1:1750 SE 28TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1080
Practice Address - Country:US
Practice Address - Phone:352-351-4634
Practice Address - Fax:352-351-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57170OtherOTHER
FL57170OtherOTHER