Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 036118526 | IL |
NPI | 1275710758 |
---|---|
Provider Name | Kemka S Ogburia JR. |
First Address | Longwood, FL 32750-4981 |
Second Address | Longwood, FL 32750-4981 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2008 |
Last Update Date | 18/08/2014 |