Individual
DR. MARY L OGRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5190 BAYOU BLVD, #7, PENSACOLA, FL 32503-2194
(850) 478-1104
(850) 478-4289
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
(904) 450-6063
(904) 539-4091
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME87300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267193000
—
FL
01
—
29221
BCBS
—
01
—
C333
HEALTH 1ST NETWORK
FL
Enumeration date
08/26/2005
Last updated
04/14/2022
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