Organization
OMNICARE MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN D FRASER MD (PHYSICIAN/OWNER)
(407) 578-9142
Entity
Organization
Contact information
Practice address
1805 W COLONIAL DR, SUITE A, ORLANDO, FL 32804-7013
(407) 578-9142
(407) 578-8616
Mailing address
1805 W COLONIAL DR, SUITE A, ORLANDO, FL 32804-7013
(407) 578-9142
(407) 578-8616
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME30256
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58757500
—
FL
Enumeration date
06/05/2012
Last updated
10/24/2012
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